Paeds Cases · pain-palliative-and-end-of-life-care
Hold the goals-of-care conversation for care in the last days of life — OSCE
OSCE communication station for care in the last days of life: open the conversation, explore understanding, make a clear recommendation, address fear of abandonment, and agree a documented plan.
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Study tools
Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A four-year-old with progressive metastatic solid tumour is now bed-bound, taking only sips, with irregular breathing and increasing periods of unresponsiveness. The family wish to remain at home if symptoms can be controlled.
Candidate brief
You have eight minutes to open a goals-of-care conversation with the family in this scenario. Explore their understanding, hopes and worries; explain the clinical recommendation in plain language; address fear of abandonment; and agree next steps including documentation and support. [1][2]
References4ShowHide
- [1]Himelstein BP et al. Pediatric palliative care. N Engl J Med, 2004.PMID 15103002
- [2]McNeilly P et al. The use of syringe drivers: a paediatric perspective. Int J Palliat Nurs, 2004.PMID 15365495
- [3]Wee B et al. Interventions for noisy breathing in patients near to death. Cochrane Database Syst Rev, 2008.PMID 18254072
- [4]Greenfield K et al. A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life. Palliat Med, 2020.PMID 32228216