Engage with all multidisciplinary team members to provide quality symptom management
Timely, effective, best-practice symptom management is fundamental in the provision of quality end of life and palliative care and must include engagement between primary healthcare providers, general practitioners, end of life and palliative care specialists and all multidisciplinary team members.
Clear processes are in place to ensure there is provision of optimal, best practice physical, spiritual and psychological symptom management, as agreed by care providers, the person with the life-limiting illness, their family and carers. Processes are in place to review, respond and escalate if required, including case conferencing modalities.
Appropriate symptom management is crucial to the health outcomes and experience of the person receiving care, their family and carers.
Matters regarding appropriate medication use, non-pharmacological considerations and rationalising treatments are important.
Useful resources can be found on the NSW Clinical Excellence Commission website, which includes the Last Days of Life toolkit, Medication prescribing for symptom management – Anticipatory Prescribing Guide and Symptom Management Flowcharts.
Referrers should consider the questions and use the tools and information below when providing virtual palliative and end-of-life care.
Inform the patient, their family or carer of the virtual care modalities available, and document their preferences. Based on availability and mutual agreement, this could include their ability and willingness to travel due to wellbeing, ease and cost of travel, personal and family commitments, spiritual needs, and available technology. More about consumer support.
When treating a patient using virtual care, consider how the prescribed treatment will be easily accessible to the patient within their local community? Consider electronic scripts, faxing to local pharmacies, Store and Forward options, delivery of medications, unmanned aerial vehicles. More on legal prescription requirements.
Who else needs to attend the appointment? Any person who can support the patient can be included in a virtual consultation with their consent. Where the patient does not have decision-making capacity, is the person responsible attending the appointment? Is a support person needed? Has the patient identified a family member or carer to be included in their care discussions? Has the clinician considered the multidisciplinary advantages of having the GP, family, specialist, other health professionals and other relevant people to attend the appointment?
Do all people attending the VC appointment understand virtual care processes and etiquette? Consider factors such as lighting, framing, background, background noise levels, position of the camera and screens. Clinicians may need to provide information, model good etiquette and provide direction to patients, family and carers attending.
Does the patient, family or carer need support to navigate the virtual care platform? Consider the need for additional clinician, family or carer to be available to support the patient. Provide virtual care education resources as required.
What happens if the patient, family, or carer deteriorates, or the technology fails while I’m providing care virtually? Each team should have its own protocols for escalating care or managing technology failures during an appointment. Measures could include:
For more virtual care resources, see:
Comfort Observation and Symptom Management Chart (Adult)
Provides tailored individual symptom and comfort assessment and management for patients when their death is expected, as well as support to families and carers in managing symptoms.
Clinical Excellence Commission | Clinical tool | 2017
Last Days of Life Toolkit: Family/carer information regarding care in the last days of life
An information sheet for family and carers around what to expect when their loved one is dying.
Clinical Excellence Commission | Information | 2016
Last Days of Life Toolkit: Family/carer information regarding medications in the last days of life
An information sheet for family and carers around what to expect from medications, administered when their loved one is dying.
Clinical Excellence Commission | Information | 2016
Last Days of Life Anticipatory Prescribing Recommendations for in-patient setting (Adult)
An information resource for clinicians regarding anticipatory prescribing of medications in the last days of life.
Clinical Excellence Commission | Clinical tool | 2017
Flowcharts that assist in the assessment and management of the five symptoms commonly experienced by patients in the last days of life.
Clinical Excellence Commission | Clinical tool | 2017
HealthPathways in Pallliative Care and Advance Care Planning
Clinical tools which are designed and written for use during a consultation, that provides clear and concise guidance for assessing and managing a patient with a particular symptom or condition.
End of Life Directions for Aged Care | Toolkit | 2020
Palliative Care Outcomes Collaboration: Assessment forms
Symptom assessment tools designed to help clinicians identify and manage common symptoms at end of life.
University of Wollongong | Clinical tool | 2021
Cachexia and anaemia: what action is needed?
A discussion of cachexia and anaemia, their symptom management and support for patients and their families.
Dr Jan Maree Davis Medical Director, Palliative Care Service, South Eastern Sydney Local Health District (Southern Sector)
How to assess, manage, and deal with the side effects of pain.
Prof Melanie Lovell Senior Staff Specialist, Palliative Care Centre for Learning and Research in Palliative Care, HammondCare
A discussion of the rehabilitation needs and options following acute cancer treatment.
A/Prof Andrew Cole Chief Medical Officer, HammondCare, Senior Consultant Rehabilitation Medicine Physician, Greenwich Hospital
Hypercalcaemia in malignant disease and palliative care emergencies
Diagnosis, treatment and considerations for management.
Dr Jan Maree Davis Medical Director, Palliative Care Service, South Eastern Sydney Local Health District (Southern Sector)
An examination of neuropathic pain: the distinctive features, assessment techniques and treatment recommendations.
Prof Melanie Lovell Senior Staff Specialist, Palliative Care, Centre for Learning and Research in Palliative Care, HammondCare
Nausea and vomiting are common symptoms in palliative care and have a significant impact on patients’ quality of life.
Dr Bridget Johnson Staff Specialist, Palliative Care, Greenwich Hospital
A conversation about the role of a dietitian, of nutrition and the aim of nutritional management in palliative care and in terminal care.
Melissa Scattergood Senior Clinical Dietitian, Royal North Shore Hospital
Dr Robyn Keall, Nurse Practitioner discusses the main causes, types, assessments and treatment of pain. Robyn also gives a clear explanation of opioid conversions.
Robyn Keall Nurse Practitioner, Community Palliative Care, Neringah HammondCare
A discussion about how, why and when to consider palliative care as part of dementia care.
Dr Elspeth Correy Supportive and Palliative Medicine Consultant, Crown Princess Mary Cancer Centre Westmead, Cancer Services, Blacktown and Mt Druitt Hospitals
Respiratory symptoms and managing secretions in end of life care
Respiratory symptoms are common at the end of life regardless of underlying cause of illness.
Dr Caitlin Sheehan Staff Specialist, Palliative Care, St George Hospital and Calvary Health Care Kogarah
Speech pathology and palliative care
An overview of the role of the speech pathologist in palliative care and their importance in maintaining quality of life for patients.
Prudence Gourley Speech Pathology Manager, Macquarie Health Speech and Hearing Clinic, Macquarie University