Key tasks and domains of care for the initial consultation
| Domains and principles of care* | |
| Task | Description |
| Coping and support | |
| Explain palliative care | Address misperceptions about palliative care and explain the focus of palliative care on improving quality of life, addressing symptoms proactively, supporting the patient and family, and planning for the future |
| Initiate the therapeutic relationship | Establish an atmosphere in which the patient and their family can experience a sense of support and security, and communicate freely. Enquire about and respect individual preferences and cultural practices |
| Assess distress and coping | Assess psychological and spiritual distress and coping of the patient and family |
| Enquire about social support | Determine who are the patient’s main supports and caregivers and assess the need for community supports; consider the family/caregivers as part of the unit of care |
| Symptom control | |
| Review cancer history | Review history of cancer, treatment, toxicities, complications and comorbidities |
| Assess symptoms | Assess symptoms systematically, and discuss treatment strategies with the patients and their family† |
| Reconcile medications | List medication dosage, frequency and route; compare against previously listed medications; assess need for medications and deprescribe as appropriate |
| Decision-making andfuture planning | |
| Enquire about goals of care | Review goals of care from the perspective of the patient and family. Introduce the role of the palliative care team in providing advice in accordance with these goals |
| Flexible, attentive, patient-led and family-centred | |
| Provide team-based care | Assess the need for involvement of other members of the palliative care team (social workers, physiotherapists, occupational therapists, spiritual care workers, dieticians, etc). Inform oncology team and family physician of the care plan |
| Ensure understanding and engagement in care | Educate and engage the patient and family in the care plan; summarise and allow time for questions; provide contact information and explain 24/7 care |
*Core domains are listed for each task, although other domains may also be relevant. All tasks are enacted according to the principles of care: flexible, attentive, patient-led and family-centred; tasks that are related specifically to these principles are also delineated.
†Treatments for symptoms include not only pharmacologic but also non-pharmacologic interventions, such as consultations for palliative radiation oncology, interventional radiology (eg, for stents or drains), anaesthesia (for nerve or plexus blocks), procedure clinic (for paracentesis or thoracentesis), or physical or occupational therapy.