Clinical management – Domain 2

This domain includes the knowledge and skills required to provide holistic, high-quality clinical care of the person, their family and carers.

2.1 Impeccable assessment

The following learning items relate to National Palliative Care Standard 1.

The learning items below are relevant to the entirety of 2.1 Impeccable assessment.

Learning item Resource
2.1.1. Holistic palliative care assessment of the person which includes: 
  • clinical history 
  • physical examination
  • developmental assessment including communication (children)
  • identifying deterioration across the continuum
  • recognising frailty
  • clinical investigations
  • family/siblings/carer(s)
  • psychosocial
  • spiritual
  • cultural
  • loss and grief
2.1.2. Use of evidence-based, standardised clinical assessment toolsand  methods,e.g. Palliative Care Outcomes Collaboration (PCOC) assessment tools 
2.1.3. Use of Goals of Patient Care process
2.1.4. Use of disease-specific triggers 
2.1.5. Identifying and reporting clinical and psychosocial risks 
2.1.6. Applying palliative care assessment during increasing decline and in the last days of life 
2.1.7. Analysing ongoing assessment and prioritising the care needs of the person, family/carer(s):
  • identifying Goals of Patient Care
  • identifying and responding to actual and anticipated needs of the person and their family/carer(s)
  • clinical investigations
  • identifying deterioration and transition to the terminal phase
  • identifying complexity
  • anticipating disease trajectories and mitigating risks
2.1.8. Equipping the team to respond to the assessment needs of the person, family/carer(s) through:
  • palliative care triage
  • receiving and making referrals
  • inter-team referral
  • inter-hospital referral
  • consultation with other specialties
  • referral to other settings for care
  • evaluation of care

2.1.9. Responding to the needs of the individual and patient population:prioritisation and resourcing

  • establishing appropriate modes of service delivery (e.g. consultancy versus direct care)
2.1.10. Plan, implement, monitor and evaluate clinical assessment processes:
  • quality improvement including audit analysis
  • clinical benchmarking and use of data (local, state, national and international), e.g. Palliative Care Outcomes Collaboration (PCOC)
2.2 Pre-emptive care planning and clinical practice

The following learning items relate to National Palliative Care Standard 2, 3 and 4.

The learning items below are relevant to the entirety of 2.2 Pre-emptive care planning and clinical practice.

Learning item Resources
2.2.1. Holistic care planning which considers:
  • person, family/siblings/carer(s)
  • a wellness model of care
  • specific disease trajectories
  • independence and supports the person’s wishes, their autonomy and locus of control
  • cultural and spiritual needs
  • rehabilitation
  • pre-emptive care
  • Advance Care Planning
  • documenting and communicating
  • The spiritual dimension of palliative care (external site)
    Palliative and Supportive Care Education (PaSCE)
    *Resource offered as part of a fixed program of events and are only available on certain dates. Follow the link to access the events calendar or contact Cancer Council WA for more information.
2.2.2. Incorporates curative and other treatment, modalities, therapies and procedures
2.2.3. Care planning during transitions
2.2.4. Care planning during increasing decline and last days of life including the care plan for the dying person
2.2.5. Care planning to incorporate integrative/complementary care
2.2.6. Initiating and supporting the Goals of Patient Care process
2.2.7. Initiating advance care planning conversations
2.2.8. Roles and responsibilities in multidisciplinary care planning
2.2.9. Rapid response to changing and escalating needs
2.2.10. Advance CPR decision-making
2.2.11. Integrating end-of-life and palliative care planning with other treatment modalities,procedures and therapies
2.2.12. Care planning for anticipated disease processes and trajectories
2.2.13. Condition specific end-of-life care planning
2.2.14. Review and evaluation of care plans
2.2.15. Pre-empting after hours care

2.2.16. Organisational policy, quality improvement and clinical governance that support the care planning needs of individuals and patient population including:
  • clinical governance
  • advance care planning
  • Advance Health Directives and Enduring Power of Guardianship
  • Goals of Patient Care
  • care throughout the end-of-life trajectory
  • care plan for the dying person
  • Voluntary Assisted Dying
  • after hours care provisions
  • planning for humanitarian crises, including a pandemic situation
2.2.17. Formal processes to review, evaluate, reflectively practice, and improve care e.g. team meetings, Grand Rounds, audit and benchmarking 
2.2.18 Policy development which underpins supportive care, including integrative care              
2.3 Prevention and relief of suffering

The following learning items relate to National Palliative Care Standard 2, 3 and 4.

Learning item Resources
2.3.1. Considers the person and the family/carer(s) to ensure the plan of care encompasses:
  • the underlying disease, advancing illness and comorbidities
  • related treatments (short- and long-term effects), therapies and modalities of care
  • common and disease-specific symptoms
  • pharmacology
  • additional care needs e.g. malignant wound management
  • person and family/carer(s) education
  • integrative and complementary therapies
  • cultural and spiritual needs
2.3.2. Preventing, recognising and responding to holistic suffering including:
  • differing perspectives (person, family/carer(s), team, staff)
  • impact on family and community
  • dealing with myths, the attitudes of others
  • treatment modalities; benefits versus burdens
  • hope/suffering
  • impact on health professionals and staff
The learning items below are relevant to the entirety of 2.3 Prevention of relief and suffering 
2.3.3. Anticipates, responds to and reviews the impact on the person, family/carer(s) of: 
  • the disease, advancing illness and comorbidities
  • related treatments (short- and long-term effects), therapies and modalities of care
  • common and disease-specific symptoms and sequalae
  • new and escalating symptoms
  • pharmacology
  • the meaning attached to symptoms and deterioration
  • palliative care emergencies
2.3.4. Advocating for the person, their family/carer(s) and colleagues
2.3.5. Managing critical incidents
2.3.6. Strategies to address the effects of suffering on colleagues and self
Extension 2.3.7. Managing complexity:
  • in individuals
  • in the patient population
  • during humanitarian crises e.g. pandemic
2.3.8. Implications of resource management
2.3.9. Creating a climate for clinical reasoning, advocacy and consumer opinion
2.3.10. Formal strategies for risk mitigation
2.3.11. Systems for supporting existential distress in health professionals and staff including formal debriefing, accumulative impact and reflective practice
2.3.12. Governance of critical incidents
2.4 Chronic disease management

The following learning items relate to National Palliative Care Standard 4 and 5.

2.4.1. Pathology of diseases during advancing illness and at end-of-life
2.4.2. Chronic disease from diagnosis to death:
  • natural history
  • pathophysiology
  • disease trajectories
  • co-morbidities and multi-morbidities
  • person’s perspectives and disease meaning
2.4.3. Planning for and managing the person at home
2.4.4. Education of the person and family/carer(s)
2.4.5. Quality of life: wellness, independence and rehabilitation
2.4.6. Survivorship in palliative care

The learning items below are relevant to the entirety of 2.4 Chronic disease management

2.4.7. Prognosis in chronic diseases:
  • co- and multi-morbidities
  • treatment and management
  • identifying decline
  • managing transitions
  • predicting death
2.4.8. Rationale in pharmacological interventions
2.4.9. Mentoring and fostering learning in end-of-life and palliative care across general healthcare and other specialities
2.4.10. Supporting quality of life in clinical practice: 
  • individual autonomy
  • person, family/carer(s) education
2.4.11. Implementing formal shared care practices
2.4.12. Promoting creative shared care models across systems:
  • developing a treating coalition
  • building capacity across specialties
  • supporting formal programs for clinical mentoring
  • LEAN principles in care i.e. improving patient satisfaction and care outcomes while reducing costs
2.4.13. Leading and informing end-of-life and palliative care policy change across health
2.4.14. System planning for implementation of end-of-life choices
2.5 Loss, grief and bereavement

The following learning items relate to National Palliative Care Standard 6.

2.5.1. Contemporary concepts in loss, grief, bereavement, mourning and trauma
2.5.2. Different grief responses and trajectories of experience including Prolonged Grief Disorder
2.5.3. Communicating with the bereaved
2.5.4. Communication about loss, grief and bereavement
2.5.5. Recognition of own experiences, values and beliefs about end-of-life choices, death, dying and grieving
2.5.6. Historical and cultural views on death, grief and mourning
2.5.7. Grief and bereavement services and resources
2.5.8. Care of the bereaved after death
2.5.9. Psycho-social and spiritual needs of individuals and groups
2.5.10. Implications of personal and professional grief 

The learning items below are relevant to the entirety of 2.5 Loss, grief and bereavement.

2.5.11. Loss, grief and bereavement at developmental stages across the lifespan:
  • perinatal, neonatal, paediatric, adolescent loss, adult and older adult loss
2.5.12. Prolonged Grief Disorder
2.5.13. Bereavement risk assessment
2.5.14. Mental illness and loss, grief and bereavement
2.5.15. Cumulative and concurrent loss, grief and bereavement
2.5.16. Providing bereavement care 
2.5.17. Grief and bereavement care including grief support, grief counselling and grief therapy:
  • evidence-based contemporary practice
  • planning, implementing and evaluation (internal)
  • formal links with external services
  • planning for humanitarian crises
2.5.18. Prevention strategies for loss, grief and bereavement
2.5.19. Research in end-of-life and palliative care
2.6 The COVID-19 environment

The following learning items relate to end of life and palliative care in the COVID-19 environment.

Learning item Resources
2.6 End-of-Life and Palliative Care in the COVID-19 environment