Palliative care in cancer — branching viva

Branching viva on palliative care in childhood cancer: the World Health Organization definition and the concurrent parallel model, the early referral at the high-risk diagnosis, the World Health Organization analgesic ladder and the opioid stewardship, the goals-of-care and advance care planning conversation, the anticipatory medicines for the last days of life, and the bereavement follow-up and the sibling support.

branching clinical structured oral1 min readVerification in progress

Prompt

Outpatient clinic: an eight-year-old girl with relapsed medulloblastoma is admitted with a severe pain flare and exhausted parents, while the oncology team weighs another line of treatment. The examiner asks for the World Health Organization definition of palliative care and the concurrent model, then branches to the symptom assessment and the analgesic ladder, to the goals-of-care conversation, to the anticipatory medicines for the last days of life, and finally to a sixteen-year-old with refractory leukaemia at home that opens the place-of-care decision and the bereavement and sibling support.

Opening question

An eight-year-old girl with relapsed medulloblastoma is admitted with a severe pain flare, her parents exhausted and frightened. Give the World Health Organization consensus definition of palliative care, and explain the concurrent parallel model that runs the palliative care alongside the disease-directed therapy from the diagnosis of the high-risk disease. [1][2]

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You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References4Show ledger

[1]Radbruch L, De Lima L, Knaul F, et al. Redefining Palliative Care-A New Consensus-Based Definition. J Pain Symptom Manage, 2020.PMID 32387576
[2]Snaman JM, McCarthy S, Wiener L, et al. Pediatric Palliative Care in Oncology. J Clin Oncol, 2020.PMID 32023163
[3]Zernikow B, Smale H, Michel E, et al. Paediatric cancer pain management using the WHO analgesic ladder--results of a prospective analysis from 2265 treatment days during a quality improvement study. Eur J Pain, 2006.PMID 16243549
[4]Johnston EE, Rosenberg AR Palliative Care in Adolescents and Young Adults With Cancer. J Clin Oncol, 2024.PMID 37862672