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Palliative Care for FY1s

Welcome

Welcome to the palliative care for FY1s resources page! This page contains webinars and resources to help newly graduated medical students feel prepared to provide palliative and end-of-life care as foundation doctors. Content produced by the APM Juniors’ Committee.

Recordings

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Got a question for one of our speakers? Submit your question here.

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Resources

End-of-Life Care For All

(e-ELCA) E-learning

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Palliative Care Guidelines

West Midlands Palliative Care Guidelines

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Palliative Care Knowledge Zone

Marie Curie Palliative Care Knowledge Zone

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Paediatric Palliative Care Resources

APPM Prescribing Guidelines

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Palliative Care in Paediatrics Guide

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Together for Short Lives Resources

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The palliative medicine communities’ tips for new foundation doctors

We asked the palliative care community on X what tips they would give new foundation doctors for providing palliative care and for caring for patients with life limiting conditions. Here’s what they told us…

Communication

  • LISTEN – A lot of palliative care is pulling up a chair and giving time to really listen to what the patient tells you. What is bothering *them* is more important than preconceived ideas we may have. Then being able to make a plan together with them.
  • Use clear communication with unambiguous language. Don’t be afraid to say death/dying. Avoid “passed away” or other phrases that may be misunderstood.
  • Learn to listen… properly listen Understand your perspective may be very different from your patients. Silence may sometimes be your most powerful tool.
  • Take the time to read the room – everyone is different and figuring out who someone is as a person is time best spent. Listen more than you speak. Acknowledge and respect the uncertainty.
  • Allow time to listen to your patients and their loved ones, give space and allow pauses in conversation, learn to sit with distress – you cannot fix everything, ascertain what is important and matters most to the person. Shared decision making allows people with little control over their conditions to retain some – which can be really powerful, don’t be afraid to use ‘D’ words and something I like to use in conversation is ‘I wish, I worry, I wonder.
  • Be inquisitive and empathic. Think about the person not the patient, including those close to them. And never feel anxious about asking for help!
  • After you’ve done all the listening bit, and the holistic assessment bit, ask… ‘What have I not asked?’ ‘What’s most important for you right now?’ It’s often not what you think it might be based on your assessment!
  • Compassionate truth telling. Being honest about what’s going on with kindness and compassion to empower and support.
  • Please speak to any family or friends that the person may want to be around and included in any decisions.
  • Be open about sharing uncertainties (improvement in symptoms, prognosis, progression) and follow it up with what you might be able to do in different situations. It can be very reassuring for patients and their loved ones
  • Use less ambiguous language when talking about EOL/death. Understand patients’ priorities. Reassure that there is help at every step as things change. Don’t rush your interaction – time is important.
  • I know it’s often difficult but slow down and listen. Pull up a chair and ask what their concerns are.
  • Don’t ever say you are “making someone palliative” or “putting them on the pathway” or we send you straight to palliative care jail.
  • Pull up a seat…. never initiate difficult conversations standing over a patient. Sit. Listen. And listen again.
  • Sit down, lean forward, and listen…

Advance care planning

  • Follow your instincts and parallel plan if someone is sick enough to die they may well do whatever you do so communicate that clearly and always use the expertise of the palliative care team alongside critical care.
  • Finding out the patients’ goals & wishes for their remaining time & to the extent that they are comfortable, their preferences for EOL care.
  • Learn about advance care planning. Include advance care planning from the very first interaction you have for all patients with a life limiting illness.
  • Think about the person in front of you. What are their wishes? What are their limits? Will this next test, or the frequency of current tests, change or add something to their care? Be less protocol driven.
  • Have the conversations early regarding advanced care planning and be flexible and realistic- people change their minds further on in the journey.

Caring for the dying person

  • Some patients are sick enough to die. They may pull through. They might not. Say ‘sick enough to die’ to pt & family. Not ‘serious.’ Not ‘critical.’ Not ‘unstable.’ Name death as a possibility, & plan good end of life care in parallel with current treatment plan. If your patient is sick enough to die, get support from your seniors and/or pall care team. Patients who see the pall care team are not obliged to die. Pall care can help you with parallel planning, support pt/family/staff (you!), in ER, wards or ICU. A common complaint from families when patient dies is ‘we didn’t realise s/he might die!’ They are told about sepsis/low oxygen sats/hypotension/poor blood supply to vital organ(s) but this doesn’t communicate ‘sick enough to die.’ Use your D-words. When someone who was ‘sick enough to die’ gets better, everyone is delighted. That’s a win. When they don’t, the mental preparation time for families can make a big difference to their bereavement. That’s also important.
  • It’s acceptable to continue active treatment (i.e., antibiotics) in some cases in someone on end-of-life care, as it can offer comfort that everything has been done for the patient.

Symptom control

  • Carry a pocket torch and look at you patient’s mouth regularly: mouth care is a vital but often overlooked aspect of comfort and dignity.
  • Don’t be frightened of prescribing morphine to patients with life limiting disease (with functional kidneys) If a patient has enough pain to warrant codeine (i.e., a morphine pro drug), then give them the real deal from the beginning. Or as Osler called it, “God’s own medicine.”

Holistic care

  • Understand that palliative care is not synonymous with end-of-life care, we can address symptoms & support anyone from being diagnosed with a life-limiting illness, if/when needed. This can be in parallel with other medical care (e.g ongoing chemotherapy).
  • Think outside of the purely clinical. Know where pts can get advice on benefits, blue badge access and advanced planning Then offer to refer.
  • Small things can make big differences. Be kind, be patient, listen to understand and know that there is always something you can do. Palliative care is not about doing nothing.
  • Don’t be afraid to talk openly about what you might help them with & what’s possible …they may be surprised and relieved … you are both learning.
  • Don’t underestimate the importance of psychological and spiritual concerns.

Multidisciplinary working

  • Get familiar with the local palliative care guidelines & who/how to refer to if specialist advice needed.
  • Work together as a whole clinical team. An integrated approach to care including nursing, AHPs and medical teams is essential for highest quality care for our patients and those important to them.
  • Utilise your AHP colleagues for holistic care and support.
  • A team approach and recognising the strengths of those around you is vital.

Find out more

To find out more about a career in palliative care, please see the resources below

Promotion video

APMJ Careers Webinar