Primary Care - HealthPathways Resources
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HealthPathways Resources

Clinical resources have been included that may be useful in the development and review of HealthPathways to support delivery of palliative care and advance care planning. There are eight domains of clinical care that have clinical tools and educational resources available to use, as well as information to give to your patients and their families. The eight clinical care areas are:

Clinical Tools and Resources

The Advance Care Planning Guide for General Practice (150kb pdf)
Decision Assist: Palliative Care and Advance Care Planning Support for Aged Care
A one-page guide for clinicians working in general practice to support advance care planning. It includes common triggers for advance care planning, and strategies for initiating and structuring conversations.

Patient Information

Dying to Talk, Discussion Starter: Working out what’s right for you

Palliative Care Australia
The Dying to Talk Discussion Starter provides guidance for patients to reflect on their values and preferences for end-of-life care. It supports patients to prepare for and initiate these discussions with family, friends and healthcare providers.
 

Advance Care Planning Australia

Resources for individuals:

Education and Training Resources

Advance Care Planning in Primary Care
ThinkGP
This module covers the key aspects of creating an advance care plan, the selection of a substitute decision-maker, and the legal frameworks surrounding advance care plans.

The ‘surprise’ question—Identification of Patients Approaching the end of life

The 'surprise question' is used for patients with advance disease or progressive life-limiting conditions, and is completed by asking either yourself or the care team ‘Would you be surprised if the patient were to die in the next few months, weeks, days?’

The answer to this question should be an intuitive one, pulling together a range of clinical, co-morbidity, social and other factors that give a whole picture of deterioration. If you would not be surprised, then what measures might be taken to improve the patient’s quality of life now and in preparation for possible further decline?

A palliative approach should be considered for any patient when you would not be surprised if they died within the next twelve months.

Supportive and Palliative Care Indicators Tool (SPICTTM)

The University of Edinburgh/NHS Lothian
The SPICT™ helps professionals identify people with general indicators of poor or deteriorating health and clinical signs of life-limiting conditions for assessment and care planning.

Symptom Assessment

Symptom Assessment Scale (169kb docx)
Palliative Care Outcomes Collaboration
The Symptom Assessment Scale is a self-reported tool for patients to identify what symptoms are of most concern. This assessment can also be used to identify whether treatments or medications are effective. It rates seven common symptoms—difficulty sleeping, appetite problems, nausea, bowel problems, breathing problems, fatigue and pain. The Symptom Assessment Scale and the brochures explaining the tool are available in English and also translated versions.

Pain Assessment

Clinical Assessment of Pain (156kb pdf)
Pain Australia
A guide to the clinical assessment of pain including key points of the neurological, psychosocial and musculoskeletal examination.

 

Pain Numeric Rating Scale (87.9kb pdf)

geriatricpain.org
A unidimensional single-item scale that provides an estimate of a patient’s pain intensity.

 

Modified Resident's Verbal Brief Pain Inventory (M-RVBPI) (112kb pdf)
The Australian Pain Society
This instrument designed to assist in the assessment of pain for residents that are able to communicate. The Modified Resident’s Verbal Brief Pain Inventory (M-RVBPI) provides comprehensive information about pain intensity, the site of pain and the physical and psychosocial impact of pain.

Dyspnoea (Shortness of Breath) Assessment

Modified Borg Dyspnoea Scale (22.5kb doc)
This instrument is used to measure the self-reported intensity of the sensation of breathlessness. The Modified Borg Dyspnoea Scale rates dyspnoea on a scale of 0-10 to quantify the intensity of dyspnoea during activity.

Modified Borg Dyspnoea Scale
0 Nothing at all
0.5 Very, Very slight (just noticeable)
1 Very slight
2 Slight
3 Moderate
4 Somewhat severe
5 Severe
6  
7 Very, severe
8  
9 Very, very severe (almost maximal)
10 Maximal

Patient Instructions for the Modified Borg Dyspnoea Scale

This is a scale that asks you to rate the difficulty of your breathing. It starts at number 0 where your breathing is causing you no difficulty at all and progresses through to number 10 where your breathing difficulty is maximal. 'How much difficulty is your breathing causing you right now?

Delirium Assessment

Confusion assessment method (CAM) short form (141kb pdf)
Island Health
An assessment instrument that can be used to detect the presence of delirium in individuals.

Nutrition Assessment

Mini-Nutritional Assessment Short-Form (MNA®-SF)
Société des Produits Nestlé S.A.
This screening tool is used to identify older adults over 65 years of age who are malnourished or at risk of malnutrition. The supporting website provides more information on the tool. To download the tool you need to agree to the website terms and conditions.

Psychosocial Distress

Clinical practice guidelines for the psychosocial care of adults with cancer (175kb pdf)
National Cancers Control Initiative
This summary has been developed to assist health professionals in providing optimal evidence-based psychosocial care for adults with cancer, and their families. Prepared by the National Breast Cancer Centre and the National Cancer Control Initiative with funding from the Australian Government, Department of Health and Ageing, this summary provides an overview of the key emotional issues to consider when treating patients with cancer. It includes practical recommendations about specific interventions to promote adjustment, and detect and treat emotional disorders.

 

Kessler Psychological Distress Scale (K10) (64kb pdf)
Black Dog Institute
The K10 is a simple measure of psychological distress as a measure of outcomes following treatment for common mental health disorders. The K10 asks 10 self-reported questions with a 5-value scale. The maximum score is 50 indicating severe distress and the minimum score is 10 indicating no distress.

 

Carers needs assessment tool
NAT-CC — Caring for you: Needs Assessment Tool
University of Queensland
The NAT-CC is a self-reported tool for caregivers to identify the care needs of someone living with a chronic condition, and the level of concern they cause. This provides prompts for the caregiver and/or the health professional to discuss these issues.

Anxiety and Depression

Anxiety
CareSearch
This webpage describes the clinical evidence supporting patient symptom management for anxiety in palliative care.

 

Depression
CareSearch
This webpage describes the clinical evidence supporting patient symptom management for anxiety in palliative.

Appetite

Appetite problems
CareSearch
A website describing the clinical evidence supporting patient symptom management for appetite problems in palliative care.

Bowels

Constipation
CareSearch
A website describing the clinical evidence supporting patient symptom management for constipation in palliative care.

 

Bowel care and intestinal obstruction in end of life care
The Palliative Care Bridge
An interview with Dr Bridget Johnson provides an overview of the causes and management of constipation and bowel obstruction and the importance of differentiating between the two.

Breathing

Breathing
CareSearch

A website describing the clinical evidence supporting patient symptom management for breathing difficulties in palliative care.

Delirium

Delirium
CareSearch
A website describing the clinical evidence supporting patient symptom management for delirium in palliative care.

Fatigue

Fatigue
CareSearch
A website describing the clinical evidence supporting patient symptom management for fatigue in palliative care.

Nausea and Vomiting

Nausea
CareSearch
A website describing the clinical evidence supporting patient symptom management for nausea in palliative care.

 

Pain

Pain
CareSearch
A website describing the clinical evidence supporting patient symptom management for pain in palliative care

 

Cancer guidelines wiki: Cancer pain management in adults
Cancer Council Australia
This guideline provides brief point-of-care recommendations for screening, assessment and management of cancer-related pain in adults. It focuses on chronic pain rather than acute pain caused by cancer treatments or pain in cancer survivors (which is best addressed by referral to a specialist pain medicine physician). The guideline makes recommendations about both pharmacological and non-pharmacological management as well as patient awareness and self-management.

Sleep

Difficulty sleeping
CareSearch
A website describing the clinical evidence supporting patient symptom management for difficulty sleeping in palliative care.

Airway Obstruction

Airway obstruction
CareSearch
A website describing the clinical evidence supporting management of airway obstruction in palliative care.

Bleeding and Haemorrhage

Major bleeding
CareSearch
A website describing the clinical evidence supporting management of major bleeding in palliative care.

Bowel Obstruction

Bowel obstruction
CareSearch

A website describing the clinical evidence supporting management of bowel obstruction in palliative care.

Seizures

Seizures
CareSearch
A website describing the clinical evidence supporting management of seizures in palliative care.

Spinal Cord Compression

Spinal cord compression
CareSearch
A website describing clinical evidence on management of spinal cord compression in palliative care.

Medications Management

Prescribing tips—How to start an opioid
CareSearch

A website providing clinical support for commencing opioids in palliative care.

 
Opioid conversion guidelines
eviQ—Cancer Treatments Online

A website providing clinical guidelines for opioid conversion. This website requires users to register to access information.

 
Opioid Dose Equivalence (88kb pdf)
Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists (ANZCA)

This document provides calculation of oral morphine equivalent daily dose (oMEDD).

Syringe Drivers

Guidelines for subcutaneous infusion device managements in palliative care
Queensland Health

Guidelines to inform practice, development of policy and procedures, and associated training and education programs for clinicians and palliative care services in relation to portable subcutaneous infusion device management.

Patient Information

What is palliative care?
Palliative Care Australia
Palliative care is for anyone of any age, who has been told that they have a serious illness that cannot be cured. These brochures talk about what palliative care is, who it is for and how to source.

Education and Training Resources

Factsheets

Providing medication for pain and symptom relief
End of Life Directions in Aged Care (ELDAC)
A factsheet providing information on responsibilities around providing medication for pain and symptom relief.
 
Futile and non-beneficial treatment
End of Life Directions in Aged Care (ELDAC)
A factsheet providing information on the delivery of futile and non-beneficial treatment.

Clinical Tools and Resources

Case conference resource guide (196kb pdf)
Albury Wodonga Regional GP Network
This resource guide was developed to assist general practitioners who wish to organise or participate in case conferences for patients with complex needs.
 

Coordinating palliative care

CareSearch
A website providing information and resources on care coordination in palliative care.

Patient Information

How and why to hold a family meeting (56kb pdf)
Carers Victoria/New South Wales
A factsheet for patients and their families and carers on how and why to hold a case conference/family meeting.

Clinical Tools and Resources

Implantable cardioverter-defibrillators at end of life
Palliative Care Network of Wisconsin
This fact sheet providing information on implantable cardioverter-defibrillators at the end of life.
 
Cardiac pacemakers at the end of life
Palliative Care Network of Wisconsin
A factsheet providing information on pacemakers and deactivation at end of life.

Education and training resources

Withholding and withdrawing life-sustaining medical treatment
End of Life Directions in Aged Care (ELDAC)
A factsheet providing information on responsibilities around withholding and withdrawing life-sustaining medical treatment.

Clinical Tools and Resources

Prescribing information: for managing common end of life symptoms
CareSearch
This webpage provides prescribing information for common symptoms when death is likely in days, including anxiety and emotional distress, delirium, excessive secretions, nausea and vomiting, pain and shortness of breath. This information is based on the PalliAGED – ‘Prescribing in the terminal phase’.

 
End of life (Terminal) symptom management medications for older Australians living in the community (146kb pdf)
Australian and New Zealand Society of Palliative Medicine Inc. (ANZSPM)
A summary of prescribing advice for medicines suitable for use in community aged care for the management of symptoms in the last days of life.
 

Checklist - Planning for an expected home death
CareSearch

A checklist for general practitioners when planning for an expected home death. Main topics include:

  • clarifying expectations and support,
  • assessing the home situation,
  • planning for symptom management, and information that families need.

Patient / Consumer Information

The dying process
Palliative Care Australia
This leaflet asks the question what does dying look like? What are the changes that happen and what should you do?
 
Considerations for a home death
Canadian Virtual Hospice
The purpose of this article is to outline some of the potential challenges and rewards that come with a home death. That way, both patients and caregivers can have a better idea of what might be expected.

Abnormal grief
CareSearch
A webpage providing information and resources on abnormal grief processes, including ‘prolonged grief disorder’ and ‘complicated grief’.

Palliative Care Australia (PCA) 2018, The National Palliative Care Standards (the Standards): 5th Edition – 2018, Palliative Care Australia, Sydney.

Clinical Tools and Resources

Form 6: Modified bereavement risk index (69kb pdf) (from Module 2 What is a Palliative Approach)

Palliative Approach (PA) Toolkit for Residential Aged Care Facilities

The modified Bereavement Risk Index (BRI) is a tool that should be completed with the patient’s family member/s as death approaches to identify those at risk of experiencing a more difficult grief reaction. The index provides recommendations for the need for information, support and/or referral depending on the BRI score.

Consumer Information

Understanding grief
Palliative Care Australia

Everyone experiences grief in their own way. This resource provides information on the grieving process, how should you feel and for how long?

Page updated 18 March 2019