Palliative Care
Draft proposed by Dr Rever Li, Dr Stephen Chan
Reviewed by Dr Florence Lee
Essential Skills
Domain 1 Professional Values & Behaviour
Domain 2 Communication
Domain 4 Patient Management
Additional desirable skills are listed in each proposal. These recommended skills are to be acquired as opportunity arises
Basic Training
Philosophy of Paediatric Palliative Care
Understand the definition of ‘holistic care’ and how it applies to medical care of children
Understand the terms ‘physical’, ‘spiritual’, ‘social’ and ‘psychological/emotional’ in relation to children needing palliative care
Basic knowledge of types of common non-malignant conditions requiring PPC
Understand the principles of balancing burden and benefit in considering intervention
Pain
Know that pain is poorly recognised, under- estimated and under-managed in children and infants
Be aware of simple pain scales such as face scales and Visual Analogue Scale.
Be aware that development alters the interpretation of these scales
Be familiar with WHO Pain Guidelines for children
Respiratory symptoms
Understand the definition and subjective nature of dyspnoea
Have knowledge of diagnosis and treatment of major reversible causes of dyspnoea in children on PPC care
Ethics and Law
Know the four main principles of: autonomy, non- maleficence, beneficence and justice
Understand the local/international guidelines for withholding/withdrawing life-sustaining treatment
Higher Training
Philosophy of Paediatric Palliative Care
Recognises features of nonpathological behaviours and psychological responses associated with life-limiting conditions (e.g. anger and adjustment reactions).
Know what local agencies are available to support children and families for problems in each dimension (physical, psychological, social and spiritual)
Appreciate roles of non-medical professionals in providing holistic care, especially nurses, social workers, play specialists, psychologists and chaplains, and initiate appropriate referrals
Pain
Be able to use appropriate pain assessment tools effectively within the context of the pain to which they apply
Understand the limitations of pain scales in children with developmental delay and/or other communication difficulties
Understand the use of opioid as an effective pain control in end-of-life
Recognise the need to address emotional, psychological, social and spiritual needs as well as physical ones in managing pain
Respiratory Symptoms
Have knowledge of pathophysiology of dyspnoea in children with malignant and non-malignant conditions e.g., CP, DMD, children with lung metastases
Understand and apply the principles of pharmacological and non-pharmacological management of dyspnoea, including the place of oxygen therapy
Be aware of MDT approach to management. e.g. psychologist, play specialist, physiotherapy
GI Symptoms
Understand the pathophysiology of hiccough, nausea, vomiting, constipation and diarrhoea in PPC, and initiate appropriate management
End of Life Care
Have knowledge in symptoms and signs indicative of imminent death, and initiate appropriate management
Be aware of different routes to administer medications/IVF (e.g.sSubcutaneous, buccal, intranasal)
Recognize the psychological stress of the parent/family members facing the dying child. Respect the wish of the dying child and family, and willing to work with the MDT to meet their needs
Ethics and Law
Understand the issues of euthanasia and its local implications
Understand the ethics principal and knowledge on diagnosis of brain-stem death
Communications
Understand the developmental models of children’s view of death
Bereavement
Understand the general concepts of loss, grief and mourning.
Understand basic theories about bereavement: process of grieving, adjustment to loss
Be able to anticipate and identify abnormal, prolonged and complicated grief in children and adults
Desirable skills
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Breaking bad news (e.g. SPIKE model)
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Be able to conduct a DNACPR or ACP (Advance Care Plan) discussion with the child and parents/carers
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Empathetic listening to facilitate appropriate open discussion with both the child and parents / carers