Core Adult Internal Medicine Disciplines

Palliative Medicine

Topics

• Principles of palliative care; their application in advanced disease.
• Liaison with multidisciplinary hospital, hospice and community palliative care services.
• Physical aspects of palliative medicine:
  • Natural history, including symptomatology of common incurable diseases.
  • Pain control, including assessment, psychological factors, treatment and monitoring.
  • Management of conditions and symptoms common in incurable and life threatening disease - including hypercalcaemia, mouth problems, anorexia, weakness, nausea and vomiting, dyspnoea, intestinal obstruction, constipation, diarrhoea, incontinence, anxiety, depression, restlessness, malignant effusions and ascites, lymphoedema.
• Management of emergencies in palliative care - acute confusional states, haemorrhage, acute severe pain, spinal cord compression, fits, superior venal caval obstruction.
• Pharmacological aspects of palliative medicine:
  • WHO classification of analgesics, their dose equivalents and alternate routes of administration.
  • Pharmacology of drugs commonly used in symptom control.
  • Prescribing: knowledge of regulations governing the prescription of controlled drugs.
• Psychosocial aspects of palliative medicine:
  • Communication with terminally ill patients, their relatives and health care professionals with respect to information transfer, therapeutic strategy
  • Quality of life issues and their relevance in late stage disease.
  • Psychosocial responses of patients and relatives in illness and bereavement.
  • The support of families in bereavement.
• Religious and cultural aspects and influences on patient and family attitudes to death and dying.
• Ethical issues: the ethical framework for appropriate interventions in patients with life threatening disease, including truth telling, consent, treatment choice, the question of euthanasia and advance directives, boundaries of palliative care.
• Legal and organisational: certification of death; procedures after death.

Practical Skills for all Trainees

Counselling of patients and their families on the palliative or conservative management.

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