Palliative care

WHO Palliative Care


Palliative Care Rural Health West au

Palliative Care Formulary PCF4 (£49.99 ahem)


Cancer breaking bad news


Palliative care fast facts

End-of-Life Physician Education Resource Center


Advanced care planning


EOL pathways cancer palliative care

NHS EOL Publications

RCN Route to Success Nursing Care in EOL pathways

EOL Liverpool Gold Standard Pathway

GMC Treatment and care towards the end of life: good practice in decision making 

Better Environments for EOL Care@ NHS Networks Aug 2011

 Prognosis in Palliative Care BMJ Aug 2011

Fact sheet 11 Liverpool Care Pathway
The Liverpool Care Pathway is an integrated pathway tool which can be used during the last 72 / 48 hours of life. It provides guidance on the different aspects of care required, including comfort measures, anticipatory prescribing and discontinuation of inappropriate interventions.
There are three sections to the tool Diagnosing dying, Ongoing assessment and Care after death
Key elements
A multidisciplinary team approach
Initial assessment of patients condition and comfort
Communication with the patient, family and significant others
Identification of religious and spiritual needs
Agreed plan of care
Anticipatory prescribing
Symptom control Pain, agitation, nausea and vomiting, respiratory secretions, breathlessness.
Agree and cease unnecessary interventions
Ongoing assessment, recording and amendment to plan if required
Care after death inform GP
Provide appropriate information to family

ACP Guidelines SCHP
ACP is an aspect of care planning which can only be undertaken by a person who has capacity to decide.The outcomes of ACP might include one or more of:
• Advanced statement to inform subsequent best interest discussions (PPC preferred priorities of care document)
• Advanced decision to refuse treatment. (ADRT) A more specific, legally binding document
• Appointment of LPA (lasting power of attorney)

A few things to remember:
ACP is voluntary
ACP can only involve people who have capacity
There should be no pressure on the patient from the family, carer or healthcare professional to participate in ACP
Not everyone will be comfortable in talking about ACP
There is evidence that ACP discussions on admission to a care home may cause distress, but can be successful once a person has had time to settle and if staff are appropriately trained
ACP should be considered followinCare planning (usually ceiling of treatment discussion in our patient population) to be undertaken by appropriately trained clinicians, currently Julie and GPs. We must ensure that all GPs are willing and trained in ceiling of treatment discussions.
Formal assessment of capacity documentation by the clinicians doing ACP/CP before discussions


Handover (ooh)

Hacking-medschool/handover-prescribing Palliative Care Handover Form for OOH Service

yac palliative ooh service OOHs

Nurses Verbal Handovers
(a bit poor)
SNCSG Pearson 2006
H Have essential information ready before uou begin . Include:
A Any changes in patients/family situation
N normal parameters that have eviated
D Doctors rounds – changes in treatment /management plans
O Objective Data vital signs + relevant subjective data
V Viscous statements – avoid personal opinions / gossip
E education – what has been said to patient/family
R relevant and priority care for next shift




Macmillan nurses

Macmillan Nurses


Oncology emergencies

Oncological Emergencies Spinal Cord Compression


Hypercalcaemia in oncology


Spinal Cord Compression

NICE CG75 Metastatic spinal cord compression Nov 200



SVC Obstruction

Due to mets in mediastinal lymph nodescausing compression  or invasion of SVC. Patient presents with congestion, oedema,and prominent  distended veins over upper limb chest wall neck or face.

SVCO Medscape


Neutropaenia / Pancytopaenia / Sepsis in Radio/Chemotherapy


Major haemorrhage haemorrhage


Bony Mets


Prescribing in palliative care



WHO Analgesic Ladder

WHO Analgesic Ladder

3 step approach for pain relief. Inexpensive and effective in 80-90%.
STEP 1 Non Opiod aspirin paracetamol NSAID
STEP 2 Weak Opiod for mild to moderte pain eg codeine
STEP 3 Strong Opiod Strong Opioid for moderate to severe pain eg morphine

Oral preps are preferred at all stages.
Analgesics should be given regular intervals (3-6 hourly) not on demand
Adjuvants eg anxiolytics should be considered at any step
No top dose but if morphine exceeds eg 300mg/24hr or if side effects reconsider cause of pain +/seek specialist advice.

Cancer Pain Tutorial Dr Mahibur Rahman


Cancer pain


Opiate Equivalences

Opioid dose conversion Medicine Box


Transdermal opiates Patient Safety Alert Using Fentanyl Patches Safely


Cancer Pain Adjuvants

MIMS Table Co-Analgesics for Use in Cancer Pain


Srynge drivers and compatibilities Syringe driver compatibility and dilutants Syringe compatibility chart

Managing respiratory


Breakthrough cancer pain

SIGN 106 qrg Cancer Pain Nov 08

Management of Cancer Related Breakthrough Pain Science Committee of the Association for Palliative Medicine of Great Britain and Ireland 2008


Anorexia in Palliative Care


Constipation in palliative care


Cough in Palliative Care


Dyspnoea in palliative care

Dyspnoea in Palliative Care PUK


Vomitting in Palliative Care


Restlessness and agitation in palliative care


Non Cancer Palliative Care



Improving management of bereavement in general practice based on a survey of recently bereaved subjects in a single general practice.
Br J Gen Pract. 2000 November; 50(460): 863–866.


Communication videoclips

Age UK

Bereavement in Children

Resources for Children

What to do when Someone Dies

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