End of Life Care for GPs: Your Survival Guide

⚠️

Updated Guidelines 2026: This page incorporates the latest NICE NG142 (End of life care for adults: service delivery) and NG31 (Care of dying adults in the last days of life) guidance, updated March 2026.

❤️

End of Life Care for GPs: Your Survival Guide

Because dignity in dying starts with confidence in caring

🍵 Tea-Friendly Learning

⏰ For GP Trainees Short on Time

🚩 Red Flag Focused

Last Updated: March 2026

Executive Summary: What You'll Master Today

Because you have 47 other things to do before lunch, and that's just the morning list

Clinical Skills You'll Gain

• Recognition: Identify patients approaching end of life using prognostic indicators
• Communication: Master SPIKES framework for breaking bad news
• Assessment: Conduct holistic physical, psychological, social, and spiritual assessments
• Symptom Control: Evidence-based management of pain, breathlessness, nausea
• Prescribing: Safe anticipatory prescribing and syringe driver principles
• Emergencies: Recognize and manage palliative emergencies

Legal & Practical Knowledge

• Capacity: Mental Capacity Act 2005 assessment framework
• DNACPR: Legal requirements and conversation skills
• Advance Planning: ADRT, LPA, and advance statements
• After Death: Verification, certification, and coroner referrals
• Family Support: Carer assessment and bereavement care
• Benefits: DS1500, Carer's Allowance, and financial support

📊 Quick Facts That Matter

of population dies each year

75%

want to die at home

45%

actually do (2026 data)

Downloads

Essential clinical resources and downloadable materials

Downloads

path: PALLIATIVE & END OF LIFE CARE

Web Resources

Cancer tools

End of life / palliative care

Teaching & learning resources

End-of-life planning tools

Books / reflections

The Other Side – one doctor's journey with terminal cancer

Other useful bits

Yorkshire Symptom Management App:

Apple App Store

Google Play
Palliative Care Guidelines website (syringe driver compatibility)
Dr Kathryn Mannix video – explaining dying process

Important patient resources

Quick Navigation

Jump to the section you need most urgently

🎯 Recognition & Identification 💬 Communication & Breaking Bad News 📋 Holistic Assessment 💊 Symptom Management 📝 Anticipatory Prescribing 🚨 Palliative Emergencies ⚖️ Legal & Ethical Issues 🕊️ Care After Death 🤝 Family & Carer Support

🧠 Brainy Bites: Essential End of Life Care Wisdom

Memory aids and golden rules for confident end-of-life care

Golden Rules

• Early recognition allows better planning and patient choice
• Honest communication builds trust and reduces anxiety
• Symptom control is achievable in 95% of patients
• Family support is as important as patient care
• Anticipatory prescribing prevents crisis situations
• Dignity and comfort are always possible

Remember: You don't need to be a palliative care specialist to provide excellent end-of-life care. You just need to know when to worry, when to treat, and when to refer.

❤️ Now go reward yourself with that well-deserved coffee

Memory Aids & Mnemonics

SPIKES (Breaking Bad News)

Setting, Perception, Invitation, Knowledge, Emotions, Strategy

PAIN Assessment

Palliates/Provokes, Associated symptoms, Intensity, Nature/timing

Hypercalcemia

Stones, Bones, Groans, Moans
(Kidney stones, bone pain, GI symptoms, psychiatric symptoms)

Capacity Assessment

Can they Understand, Retain, Use/weigh, Communicate?

5 Palliative Care Emergencies

Hypercalcemia, severe Haemorrhage, neutropenic Sepsis, Spinal cord compression, Superior vena cava compression

🎯 Recognition & Identification of End of Life

When to start thinking about palliative care

Key Point:

Early identification allows for better planning, symptom control, and patient choice. The "surprise question" - "Would you be surprised if this patient died in the next 12 months?" - is a useful starting point.

CANCER 🎗️ Trajectory

• Metastatic disease
• Progressive weight loss >10% in 6 months
• Declining performance status (ECOG 3-4)
• Recurrent hospital admissions
• Patient expressing concerns about prognosis

🫁 ORGAN FAILURE Trajectory

• Heart failure NYHA Class III-IV
• COPD with recurrent exacerbations
• CKD Stage 4-5 declining dialysis
• Liver failure with ascites/encephalopathy
• Multiple hospital admissions

🧠 DEMENTIA/FRAILTY Trajectory

• Unable to walk without assistance
• Urinary and fecal incontinence
• No meaningful conversation
• Unable to dress without assistance
• Recurrent infections or eating problems

❓ The Surprise Question

"Would you be surprised if this patient died in the next 12 months?"

If the answer is NO, consider:

• Advance care planning discussions
• Palliative care referral
• DNACPR discussion if appropriate
• Preferred place of care conversation
• Anticipatory prescribing

🥇 Gold Standards Framework

Three stages of identification:

🟢 GREEN: Stable but advancing disease (years prognosis)

🟡 YELLOW: Unstable, deteriorating (months prognosis)

🔴 RED: Last days/weeks of life

💬 Communication & Breaking Bad News

Having those difficult conversations

🗣️ SPIKES Framework for Breaking Bad News

Step	Action	Example
Setting	Private, comfortable environment. Sit down, maintain eye contact. Allow adequate time. Have tissues available. Consider who else should be present.	Private room, tissues, turn off phone
Perception	Find out what they already know	"What is your understanding of your condition?" "What have the doctors told you so far?" "What are your main concerns?"
Invitation	Ask permission to share information	"Would you like me to explain what the tests show?" "How much detail would you like me to go into?" "Are you the sort of person who likes to know everything?"
Knowledge	Share information sensitively	Use simple, clear language. Give information in small chunks. Use warning shots: "I'm afraid I have some difficult news..." Pause frequently to check understanding
Emotions	Respond to emotions with empathy	"I can see this is very difficult news" "This must be frightening for you" Allow silence and tears. Offer practical support
Strategy	Plan next steps together	"What questions do you have?" "What are your main concerns now?" "Who can we involve to help you?" Arrange follow-up

💬 Useful Conversation Starters & Phrases

Opening difficult conversations:

• "I'd like to talk about how you're feeling about your illness..."
• "Some patients in your situation like to plan ahead..."
• "Have you thought about what's most important to you?"

Introducing Palliative Care:

"I'd like to talk about making sure you're as comfortable as possible and that we're focusing on what's most important to you. This is called palliative care, and it works alongside your other treatments."

Discussing Prognosis:

• "I wish I could give you more certainty..."
• "We're hoping for the best but planning for different possibilities"
• "Some people live longer/shorter than we expect"
• "I wish I had better news. The scans show that the cancer has spread and is not responding to treatment. This means we're looking at months rather than years."

Exploring Goals & Values:

• "What does a good day look like for you?"
• "What are you most worried about?"
• "If your time becomes limited, what would be most important?"
• "Given what we've discussed, what's most important to you now?"

⚠️ Managing Difficult Situations

Anger:

• Acknowledge the emotion
• Don't take it personally
• Explore the underlying fear
• Set boundaries if needed

Denial:

• Don't force acceptance
• Provide information gradually
• Check understanding regularly
• Respect coping mechanisms

📋 Holistic Assessment Framework

Looking at the whole person and family

🩺 Physical Assessment Priorities

Symptom Assessment:

• Pain: Location, severity (0-10), character, triggers
• Breathlessness: At rest/exertion, triggers, anxiety component
• Nausea/Vomiting: Timing, triggers, bowel function
• Fatigue: Impact on daily activities
• Appetite: Weight loss, swallowing difficulties
• Sleep: Quality, night sweats, anxiety

Focused Examination:

• Performance Status: ECOG/Karnofsky scale
• Hydration: Skin turgor, mucous membranes
• Neurological: Confusion, weakness, reflexes
• Respiratory: Rate, effort, secretions
• Cardiovascular: Pulse, BP, peripheral perfusion
• Abdomen: Distension, masses, bowel sounds

Symptom	Assessment Tool	Key Questions
Pain	0-10 scale, PAIN assessment	Location, character, triggers, relief
Breathlessness	MRC dyspnea scale	Exertion level, rest symptoms, anxiety
Nausea/Vomiting	Frequency, triggers	Timing, food relationship, medications
Fatigue	0-10 scale	Impact on daily activities, sleep
Appetite	Weight loss percentage	Food preferences, swallowing

🧠 Psychological Assessment

Screening Questions:

• "How are you coping with everything?"
• "What worries you most?"
• "Are you sleeping okay?"
• "Do you feel sad or anxious?"

Red Flags:

• Persistent low mood >2 weeks
• Panic attacks or severe anxiety
• Suicidal thoughts
• Complete social withdrawal

🕊️ Spiritual Assessment

Gentle Exploration:

• "What gives your life meaning?"
• "Do you have any spiritual or religious beliefs?"
• "Is there anything you feel you need to do or say?"
• "What are you hoping for?"
• "What are you worried about?"

Remember: Spiritual care is not about religion - it's about meaning, purpose, and what matters most to the person.

⚠️ Red Flags - Urgent Assessment Needed

• Spinal cord compression signs
• Superior vena cava obstruction
• Hypercalcemia symptoms
• Massive haemorrhage risk
• Severe delirium/agitation
• Uncontrolled pain
• Respiratory distress
• Sepsis in context of goals

💊 Symptom Management

Evidence-based approaches to common symptoms

🎯 WHO Analgesic Ladder

Step 1: Mild Pain (1-3/10)

Paracetamol 1g QDS + NSAID (if appropriate)

Step 2: Moderate Pain (4-6/10)

Add weak opioid: Codeine 30-60mg QDS or Tramadol 50-100mg QDS

Step 3: Severe Pain (7-10/10)

Strong opioid: Morphine, Oxycodone, Fentanyl

⚠️ Opioid Prescribing Safety

Key Principles:

• Start low, go slow
• Regular + breakthrough dosing
• Anticipate and prevent side effects
• Review and adjust regularly

Side Effect Management:

• Constipation: Laxatives from day 1
• Nausea: Antiemetic for first week
• Drowsiness: Usually settles in 3-5 days
• Respiratory depression: Rare in cancer pain

Opioid	Starting Dose	Breakthrough	Notes
Morphine IR	5-10mg 4-hourly	1/6 daily dose	Gold standard, cheap
Morphine MR	10mg MR twice daily (every 12 hours)	Morphine IR	Convert when stable
Oxycodone IR	2.5-5mg 4-hourly	1/6 daily dose	Less nausea, constipation
Fentanyl patch	12mcg/hr	Morphine IR	Stable pain only

🫁 Breathlessness Management

Reversible Causes:

• Pleural effusion
• Pulmonary embolism
• Pneumonia/infection
• Heart failure
• Anemia
• Anxiety

Irreversible Causes:

• Lung metastases
• Lymphangitis carcinomatosa
• End-stage COPD
• Progressive heart failure
• Muscle weakness

Non-pharmacological:

• Fan or open window
• Positioning (upright, forward lean)
• Breathing techniques
• Activity pacing
• Anxiety management

Pharmacological:

• Opioids: Morphine 2.5-5mg 4-hourly (strong evidence)
• Oxygen: If hypoxic (SpO2 <90%) 2-4L/min via nasal cannula
• Anxiolytics: Lorazepam 0.5mg if anxious
• Bronchodilators if appropriate
• Steroids for lymphangitis

🤢 Nausea Pathways & Targeted Treatment

Chemoreceptor Trigger Zone (CTZ)

Causes: Drugs, toxins, metabolic

Treatment: Haloperidol 1.5mg ON, Metoclopramide 10mg TDS

Vestibular

Causes: Motion, inner ear, brain mets

Treatment: Cyclizine 50mg TDS, Hyoscine 0.4mg TDS

Gastric Stasis

Causes: Drugs, autonomic dysfunction

Treatment: Metoclopramide 10mg TDS, Domperidone 10mg TDS

Bowel Obstruction

Causes: Mechanical obstruction

Treatment: Cyclizine + Hyoscine butylbromide

Drug	Dose	Best for	Avoid in
Metoclopramide	10mg TDS	Gastric stasis, drugs	Bowel obstruction, Parkinson's
Cyclizine	50mg TDS	Motion, raised ICP	Heart failure
Haloperidol	1.5mg ON	Opioids, metabolic	Parkinson's
Ondansetron	4-8mg TDS	Chemotherapy	Constipation

📝 Anticipatory Prescribing

Just in case medications for symptom control

💡 Key Principle:

Start Anticipatory Medication if you think the patient has less than 6 months to live. Only costs £30 or so. Allows rapid symptom control without delay. The MINIMUM is an opioid and midazolam.

Symptom	Medication	Dose	Route	Frequency	Supply
Pain/Breathlessness	Morphine Sulfate	2-5mg SC (opioid naive) Calculate if already on opioids	SC/IM	PRN 30min-hourly	10 × 1ml ampoules (10mg/ml)
Agitation/Distress	Midazolam	2-5mg SC (adjust for frailty/background benzos)	SC/Buccal	PRN 30min-hourly	10 × 2ml ampoules (10mg in 2ml)
Respiratory Secretions	Hyoscine Butylbromide (Buscopan®)	20mg SC	SC	PRN hourly Max 120mg/24hrs	10 ampoules (20mg/ml)
Nausea & Vomiting	Levomepromazine	2.5-5mg SC	SC	12-hourly PRN (may need hourly initially)	10 ampoules (25mg/ml)

⚠️ Important Safety Points

• If 3+ doses in 4 hours with little benefit: Seek urgent advice or review
• If >6 doses in 24 hours: Seek advice or review
• Always double/triple check calculations - wrong dose can kill
• Levomepromazine additional use: Terminal agitation/agitated delirium under specialist advice

💉 Syringe Driver Principles

When to Consider Syringe Driver

Indications:

• Persistent nausea/vomiting
• Dysphagia/unable to swallow
• Bowel obstruction
• Unconscious/semi-conscious
• Poor absorption
• Patient preference

Contraindications:

• Patient/family refusal
• Infection at site
• Bleeding disorder
• Lack of appropriate support
• Drug incompatibilities

🔄 Common Drug Combinations

• Pain + Nausea: Morphine + Cyclizine (compatible in WFI)
• Pain + Agitation: Morphine + Midazolam (compatible in WFI)
• Bowel Obstruction: Cyclizine + Hyoscine butylbromide + Morphine

⚠️ Safety Considerations

Drug Compatibility:

• Check compatibility charts
• Use water for injection (WFI)
• Avoid mixing >3 drugs
• Monitor for precipitation

Monitoring:

• Site inspection daily
• Symptom control assessment
• Side effects monitoring
• Family education and support

💻 Practical Prescribing Tips

Electronic Systems Support:

• EMIS/SystmOne: Have sections to make prescribing easier
• Drop-down boxes: Medication names and doses on Anticipatory Medication charts
• Syringe Driver charts: Built-in templates available
• Ardens: Brilliant palliative care section to make life easier

🚨 Palliative Emergencies

Recognizing and managing urgent situations

🚨 The 5 Palliative Care Emergencies

H
Hypercalcaemia

H
severe Haemorrhage

S
neutropenic Sepsis

S
Spinal cord compression

S
Superior vena cava compression

🚨 Spinal Cord Compression - Oncological Emergency

Spinal cord compression is an oncological emergency. Early recognition and treatment can preserve neurological function.

⚠️ Red Flag Symptoms:

• Pain: Severe back pain, worse at night, band-like
• Motor: Weakness, heavy legs, difficulty walking
• Sensory: Numbness, tingling, sensory level
• Autonomic: Bladder/bowel dysfunction
• Gait: Unsteady, wide-based gait

🎯 Immediate Actions:

Dexamethasone 16mg PO/IV immediately
Urgent MRI spine (same day)
Oncology referral for radiotherapy
Bed rest until assessment
PPI with steroids

📞 Communication Script:

"I'm calling about [patient name] who I suspect has spinal cord compression. They have [symptoms]. I've given dexamethasone 16mg and they need urgent MRI and oncology review today. This is a potential oncological emergency."

🦴 Hypercalcemia - "Stones, Bones, Groans, Moans"

Symptoms (Stones, Bones, Groans, Moans):

• Confusion, depression, psychosis
• Nausea, vomiting, constipation
• Polyuria, polydipsia, dehydration
• Bone pain, muscle weakness
• Fatigue, drowsiness

Severity Guide:

• Mild: 2.65-2.9 mmol/L
• Moderate: 3.0-3.4 mmol/L
• Severe: >3.4 mmol/L
• Symptoms correlate poorly with level

Severity	Treatment	Setting	Goals of Care
Mild + Asymptomatic	Oral fluids, monitor	Community	Comfort focused
Moderate + Symptomatic	IV fluids + bisphosphonate	Hospital/hospice	Symptom relief
Severe	Urgent hospital admission	Hospital	Discuss with patient/family

Clinical Features:

• Stones: Kidney stones, polyuria
• Bones: Bone pain, fractures
• Groans: Nausea, vomiting, constipation
• Moans: Confusion, depression, psychosis

Management:

• IV fluids: 0.9% saline 3-4L/24hrs
• Bisphosphonate: Zoledronic acid 4mg IV
• Monitor: U&Es, calcium daily
• Avoid: Thiazides, calcium, vitamin D

🩸 Massive Haemorrhage

Massive Uncontrollable Haemorrhage can happen in 10-20% of lung cancer patients. It is a horrible thing to have to watch for the patient, their relatives and you. Mortality is super high. So, always write up midazolam for Lung Cancer patients in case this happens.

In the case of massive terminal haemorrhage, give 10mg stat doses IV or IM deltoid/gluteal until the patient is settled.

⚠️ High Risk Situations:

• Head/neck cancers near major vessels
• Lung cancer with hemoptysis history
• GI cancers with previous bleeding
• Liver disease with varices
• Anticoagulated patients
• Thrombocytopenia

📋 Anticipatory Measures:

• Dark towels readily available
• Midazolam 10mg buccal PRN
• Family education about what to expect
• Clear plan: call GP/district nurse
• Consider stopping anticoagulants
• Discuss goals of care

🚨 Acute Management:

If Conscious:

Stay calm, reassure patient, position comfortably

Family Support:

Explain what's happening, stay with them, arrange immediate bereavement support

Decision Making: Hospital transfer rarely appropriate unless clearly reversible cause and good prognosis

💉 Catastrophic haemorrhage PRN medication:

• Midazolam 10 mg IM stat if catastrophic bleed / severe distress
• May repeat 5–10 mg every 5–10 minutes if required

🫁 Superior Vena Cava Obstruction (SVCO)

Clinical Features:

• Face/neck: Swelling, plethora, cyanosis
• Arms: Swelling, prominent veins
• Chest: Dilated collateral veins
• Symptoms: Breathlessness, headache, cough
• Worse: When lying flat, bending forward

Management:

• Dexamethasone: 16mg daily
• Position: Sit upright, avoid lying flat
• Urgent CT chest: Confirm diagnosis
• Oncology referral: Radiotherapy/stenting
• Avoid: Central line insertion in arms

⚠️ When to Worry

SVCO can be life-threatening if there is:

• Stridor or severe breathlessness
• Cerebral edema (confusion, headache)
• Rapid onset (hours to days)

🦠 Neutropenic Sepsis

Risk Factors:

• Recent chemotherapy
• Neutrophil count <0.5
• Temperature >38°C
• May have minimal signs

Emergency Management:

• Immediate antibiotics (within 1 hour)
• Blood cultures before antibiotics
• IV fluids if hypotensive
• Urgent hospital admission

⚖️ Legal & Ethical Issues

🧠 Mental Capacity Act 2005 - Key Principles

Five Key Principles:

Presumption of Capacity: Every adult has the right to make their own decisions and must be assumed to have capacity unless proven otherwise
Right to Make Unwise Decisions: People have the right to make decisions that others might consider unwise or irrational
Maximize Decision-Making: All practical steps must be taken to help someone make their own decisions
Best Interests: Any decision made for someone who lacks capacity must be in their best interests
Least Restrictive Option: Consider whether the purpose can be achieved in a less restrictive way

✅ Two-Stage Capacity Test

Stage 1: Impairment Test

Is there an impairment or disturbance of mind or brain?

• Dementia, delirium
• Learning disability
• Mental illness
• Brain injury
• Intoxication

Stage 2: Functional Test

Can they:

• Understand the information
• Retain the information
• Use/weigh the information
• Communicate their decision

📋 DNACPR Decision Framework

When CPR Would Not Be Successful

Clinical decision - no need to discuss with patient unless they ask

When CPR May Be Successful But...

Discuss with patient/family about benefits, burdens, and likely outcomes

Patient Refuses CPR

Respect autonomous decision if patient has capacity

⚠️ Common DNACPR Misconceptions

DNACPR Does NOT Mean:

• Do not treat
• Withhold other treatments
• No hospital admission
• No antibiotics
• Giving up hope

DNACPR Means:

• No chest compressions
• No defibrillation
• No intubation for CPR
• Allow natural death
• Continue all other appropriate care

💬 DNACPR Conversation Guide

Opening:

"I'd like to talk about what would happen if you became more unwell. Have you thought about what kind of care you would want?"

Explaining CPR:

"CPR involves chest compressions and electric shocks. In your situation, it's very unlikely to work and could cause suffering."

Reassurance:

"This doesn't change any of your other treatments. We'll continue to focus on keeping you comfortable and treating your symptoms."

📋 ReSPECT - Recommended Summary Plan for Emergency Care & Treatment

What is it: A personalised future emergency plan. One section of the Advanced Care Plan umbrella – specifically focusing on "in the event of an emergency".

Why ReSPECT? What was wrong with DNACPR?

• DNACPR problems: Often negative for patients (not involved), negative for doctors (don't like making decisions without patient involvement)
• ReSPECT solution: Encourages INVOLVING the patient - it's their life after all
• Early involvement: Involve patients EARLY rather than late when they may not be able to make decisions

📋 Advance Care Planning

Document Type	Legal Status	Content	Requirements
Advance Statement (ADPW)	Not legally binding	Preferences, values, beliefs	Written or verbal
Advance Decision (ADRT)	Legally binding	Refusal of specific treatments	Written, signed, witnessed
Lasting Power of Attorney	Legally binding	Appoints decision-maker	Registered with OPG

💬 Advance Care Planning Conversations

Key Questions to Explore:

• What matters most to you?
• What are your fears/concerns?
• Where would you like to be cared for?
• Who would you want involved?
• Are there treatments you wouldn't want?

Documentation Should Include:

• Patient's values and beliefs
• Preferred place of care/death
• Treatment preferences
• Important relationships
• Spiritual/cultural needs

🕊️ Care After Death

Verification, certification, and immediate bereavement support

✅ Verification of Death Checklist

Clinical Examination:

• No response to verbal/physical stimuli
• No heart sounds for 1 minute
• No breath sounds for 1 minute
• No pupillary response to light
• No palpable pulse for 1 minute

Documentation:

• Date and time of death
• Your name and GMC number
• Circumstances of death
• Who was present
• Any devices removed

📜 Death Certification

When to Refer to Coroner:

• Cause of death unknown
• Death within 24 hours of admission
• Death during/related to surgery
• Suspicious circumstances
• Industrial disease
• Death in custody

💚 Immediate Bereavement Support

Immediate Needs:

• Allow time with deceased
• Offer tea/coffee and tissues
• Explain what happens next
• Provide written information
• Arrange safe transport home

Practical Support:

• Registering the death
• Funeral arrangements
• Benefits and financial support
• Bereavement counseling services
• GP follow-up appointment

🤝 Family & Carer Support

Supporting those who care for the dying

👥 Carer Assessment Framework

Physical Impact:

• Sleep disruption
• Physical exhaustion
• Own health problems
• Medication management
• Manual handling issues

Emotional Impact:

• Anticipatory grief
• Anxiety and depression
• Social isolation
• Relationship strain
• Guilt and helplessness

🛠️ Practical Support Services

Service	Provider	How to Access
Respite Care	Local Authority/Hospice	Social services assessment
District Nursing	NHS Community Services	GP referral
Equipment/Aids	Occupational Therapy	Hospital/community OT
Counseling	Hospice/Charity	Direct referral
Spiritual Care	Chaplaincy/Faith Groups	Hospital chaplain

End of Life Care for GPs: Your Survival Guide

Executive Summary: What You'll Master Today

Clinical Skills You'll Gain

Legal & Practical Knowledge

📊 Quick Facts That Matter

Downloads

Downloads

Web Resources

Cancer tools

End of life / palliative care

Teaching & learning resources

End-of-life planning tools

Books / reflections

Other useful bits

Important patient resources

Quick Navigation

🧠 Brainy Bites: Essential End of Life Care Wisdom

Golden Rules

Memory Aids & Mnemonics

SPIKES (Breaking Bad News)

PAIN Assessment

Hypercalcemia

Capacity Assessment

5 Palliative Care Emergencies

🎯 Recognition & Identification of End of Life

CANCER 🎗️ Trajectory

🫁 ORGAN FAILURE Trajectory

🧠 DEMENTIA/FRAILTY Trajectory

❓ The Surprise Question

🥇 Gold Standards Framework

💬 Communication & Breaking Bad News

🗣️ SPIKES Framework for Breaking Bad News

💬 Useful Conversation Starters & Phrases

Opening difficult conversations:

Introducing Palliative Care:

Discussing Prognosis:

Exploring Goals & Values:

⚠️ Managing Difficult Situations

Anger:

Denial:

📋 Holistic Assessment Framework

🩺 Physical Assessment Priorities

Symptom Assessment:

Focused Examination:

🧠 Psychological Assessment

Screening Questions:

Red Flags:

👥 Social Assessment

🕊️ Spiritual Assessment

Gentle Exploration:

⚠️ Red Flags - Urgent Assessment Needed

💊 Symptom Management

🎯 WHO Analgesic Ladder

Step 1: Mild Pain (1-3/10)

Step 2: Moderate Pain (4-6/10)

Step 3: Severe Pain (7-10/10)

⚠️ Opioid Prescribing Safety

Key Principles:

Side Effect Management:

🫁 Breathlessness Management

Reversible Causes:

Irreversible Causes:

Non-pharmacological:

Pharmacological:

🤢 Nausea Pathways & Targeted Treatment

Chemoreceptor Trigger Zone (CTZ)

Vestibular

Gastric Stasis

Bowel Obstruction

📝 Anticipatory Prescribing

💡 Key Principle:

⚠️ Important Safety Points

💉 Syringe Driver Principles

When to Consider Syringe Driver

Contraindications:

🔄 Common Drug Combinations

⚠️ Safety Considerations

💻 Practical Prescribing Tips

Electronic Systems Support:

🚨 Palliative Emergencies