Palliative Care

Mother and Baby
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

  1. Breaking bad news (e.g. SPIKE model)

  2. Be able to conduct a DNACPR or ACP (Advance Care Plan) discussion with the child and parents/carers

  3. Empathetic listening to facilitate appropriate open discussion with both the child and parents / carers