Objectives
  • To recognise the unique aspects of end-of-life care, such as decision-making processes, symptom management, involvement of family members and spiritual aspects

  • To understand how to recognise pseudo-refractory symptoms and when to refer to specialist palliative care teams for management of refractory symptoms

  • To understand how to maintain patients’ cognition until close to death with good symptom control

  • To be able to assess, treat and counsel patients who are approaching end-of-life

  • To incorporate the family and beloved ones into goal planning

Awareness
  • Recognition that discussions of end-of-life care and planning should begin early in the disease

  • Appreciation that multidisciplinary care is always needed to meet unique patient and family needs, including psychosocial, physical, spiritual and emotional needs

  • Recognition that oncologists should be skilled in providing primary palliative care interventions and when specialist palliative care referral is required

  • Awareness of religious and cultural differences as well as sensitivities

  • Appreciation of illness and prognosis, concrete preparation for end-of-life, and the likelihood, that the benefit and side effects of anticancer treatment meet patient goals, influence decisions for it

Knowledge
  • Familiarity with how cancer disease leads to symptoms and syndromes close to end-of-life and how anticancer treatment may influence them

  • Understanding of decisional processes regarding invasive and aggressive treatments, including prognosis, progression, probability that intervention will help, prevention, price and preferences

  • Understanding of the management of symptoms and syndromes at end-of-life, including dyspnoea, pain, nausea, diarrhoea, fatigue, weakness, anorexia, cachexia seizures, delirium, anxiety, depression and despair

  • Familiarity with the indications for and limitations of artificial nutrition and hydration at end-of-life

  • Understanding of the cultural and religious differences of individual families and needs for rituals or ceremonies at end-of-life and after death

  • Understanding of the main components of preparing for end-of-life such as legacy work, finishing business, legal preparation, premortal grief, pot-mortal caregiver role and place of death

Skills
  • Ability to describe how to elicit illness and prognosis understanding by patients and family, to prepare patients to the dying process by legacy work, grief processes, finishing business and spirituality

  • Ability to describe the indications for and limitations of aggressive care in poor performance status patients or those with short life expectancy

  • Ability to elicit from patients their understanding of their health condition, what the expected outcome will be and how therapies may impact that outcome

  • Ability to demonstrate how to communicate prognosis, including impending death clearly and sensitively

  • Ability to communicate the benefits and limitations of anticancer therapies by assessing and educating patients and family, by clarifying understanding, and by discussing and weighing options

  • Ability to run effective family care conferences by preparation and structured, sensible approach

  • Ability to coordinate and run multidisciplinary and interprofessional care conferences

  • Ability to establish patient preferences for end-of-life care, including structured advanced care planning consistent with patients’ and families’ values and care goals

  • Ability to counsel and support family members in their double role as grieving family and caregivers

  • Ability to demonstrate how to initiate and titrate essential medications for symptoms

  • Ability to follow and steer main steps of a terminal care pathway protocol together with a team

  • Ability to demonstrate how to symptomatically manage terminal delirium, dyspnoea and pain

  • Ability to identify refractory symptoms and to initiate specialist-supported palliative care, including palliative sedation

  • Ability to use physical findings to help predict the length of survival, to detail concrete consequences of preparatory steps to death and specific treatments and to communicate these to the family

  • Ability to coordinate referrals to palliative home care, nursing homes and hospice