Paeds Cases · pain-palliative-and-end-of-life-care
Hold the goals-of-care conversation for palliative care in neurodisability and genetic disease — OSCE
OSCE communication station for palliative care in neurodisability and genetic disease: open the conversation, explore understanding, make a clear recommendation, address fear of abandonment, and agree a documented plan.
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Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A nine-year-old with severe spastic quadriplegic cerebral palsy, epilepsy and recurrent aspiration is admitted for the third PICU stay this year. There is no documented advance care plan; parents are exhausted and a younger sibling is missing school to help at home.
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]Horridge KA et al. Advance Care Planning: practicalities, legalities, complexities and controversies. Arch Dis Child, 2015.PMID 25275088
- [3]Lumsden DE et al. Setting goals of care in acutely unwell patients with chronic neurodisability. Br J Hosp Med (Lond), 2018.PMID 29995538
- [4]Vemuri S et al. Conceptualising paediatric advance care planning: a qualitative phenomenological study of paediatricians caring for children with life-limiting conditions in Australia. BMJ Open, 2022.PMID 35577468