Palliative Care

Introduction

Palliative care is an interdisciplinary approach to improving quality of life for people living with serious, life-threatening, or life-limiting illness and for the people important to them. It aims to prevent and relieve suffering through careful assessment and treatment of physical symptoms together with psychological, social, practical, and spiritual concerns. Palliative care is based on need rather than on a fixed prognosis and can be provided alongside disease-directed, curative, or life-prolonging treatment.

For university students in medicine, nursing, psychology, social work, pharmacy, ethics, public health, chaplaincy, and allied health professions, palliative care is especially useful because it brings clinical reasoning, communication, teamwork, ethics, and person-centred care together. You are not only asking, "What disease does this person have?" You are also asking, "What is causing suffering now?", "What matters most to this person?", "Which treatments are proportionate to the goals of care?", and "How can the team support the patient and family?"

The image above shows supportive human contact, a recurring theme in palliative care. Compassion is not a substitute for clinical competence; high-quality palliative care combines both.

The Mayo Clinic discussion above introduces palliative care as specialised support that can accompany treatment for serious illness.

Important learning note: This course is for university education. It does not replace local clinical guidelines, supervised training, prescribing rules, emergency procedures, or individual medical advice. Drug selection, dose, route, opioid conversion, sedation, and decisions about life-sustaining treatment require patient-specific assessment and appropriate professional supervision.

Learning Objectives

By the end of this aiMOOC, you should be able to:

Palliative care principles: Explain the aims, scope, and timing of palliative care and distinguish it from hospice and care in the last days of life.
Holistic assessment: Analyse physical, psychological, social, spiritual, functional, and caregiver needs in serious illness.
Symptom management: Apply a structured assessment-to-treatment-to-reassessment approach to common symptoms without relying on one-size-fits-all treatment.
Shared decision-making: Communicate prognosis, uncertainty, values, and treatment options in a way that supports informed choices.
Interprofessional collaboration: Explain how different professions contribute to coordinated palliative care.
Clinical ethics: Reason about autonomy, capacity, proportionality, advance care planning, resuscitation decisions, and palliative sedation.
Evidence-based practice: Interpret important evidence while recognising limits in generalisability and certainty.
Equity in healthcare: Identify cultural, structural, linguistic, and socioeconomic barriers to access and propose ways to reduce them.

What Palliative Care Is

The World Health Organization describes palliative care as an approach that improves quality of life for patients and families facing problems associated with life-threatening illness by preventing and relieving suffering through early identification, assessment, and treatment of pain and other physical, psychosocial, and spiritual problems. This definition has several consequences for practice.

Palliative care is not limited to cancer. People with advanced heart, lung, kidney, liver, neurological, infectious, congenital, and other serious illnesses may have palliative care needs. It is also not limited to the final days of life. Needs can begin at diagnosis and change across the illness trajectory.

Palliative care is also not the same as "giving up." Disease-directed treatment and palliative care can occur at the same time. The balance between disease modification and comfort may change as illness progresses, but the goal is always to align care with the person's informed priorities.

A clinical examination remains important in palliative care. The difference is not that clinicians stop diagnosing; rather, they select investigations and treatments according to the likelihood of benefit, burden, reversibility, prognosis, and the patient's goals.

Palliative Care, Hospice, and End-of-Life Care

These terms overlap but should not be treated as synonyms.

Palliative care is a broad approach based on serious-illness needs. It may be primary palliative care delivered by the usual clinical team or specialist palliative care delivered by clinicians with advanced training.

Hospice care is a model of care that generally focuses on people approaching the end of life, but eligibility rules, funding, setting, and the relationship to disease-directed treatment vary by country and health system. You should therefore avoid assuming that one country's hospice rules apply everywhere.

End-of-life care usually refers to care during a period when a person is approaching death, but the exact time frame differs across policies and disciplines.

Care in the last days of life refers to the final phase when a person may be dying over days. Recognition can be uncertain, so clinicians should reassess for deterioration, stabilisation, or temporary recovery rather than treating a prediction as certainty.

The Concept of Total Suffering

A person may experience distress in several interacting domains. Palliative care often uses the concept of total pain or total suffering to avoid reducing a complex experience to a single symptom score.

Physical symptoms: Pain, breathlessness, nausea, constipation, fatigue, weakness, insomnia, delirium, and other symptoms may interact.
Psychological care: Anxiety, depression, fear, loss of control, uncertainty, trauma, and anticipatory grief can increase suffering.
Social care: Family roles, loneliness, caregiving, finances, housing, work, transport, and access to services may influence care.
Spiritual care: Meaning, hope, identity, faith, existential distress, reconciliation, and questions about mortality may matter whether or not a person is religious.
Practical support: Equipment, medication access, home care, emergency plans, and coordination affect whether a care plan is realistic.

A holistic assessment does not mean that every professional must solve every problem. It means that the team notices relevant needs, explores what matters to the patient, acts within professional competence, and involves appropriate colleagues.

Illness Trajectories and Early Integration

Serious illnesses do not all follow the same trajectory. Some cancers may show a period of relative stability followed by decline. Organ failure may involve recurrent crises and partial recoveries. Dementia and neurodegenerative disease may involve prolonged functional decline. These patterns influence communication, planning, caregiver burden, and service design.

The neuropalliative roadmap above uses a journey metaphor from diagnosis to death. A useful lesson is that palliative needs can arise at multiple points rather than only when disease-directed treatment ends.

Evidence from oncology has helped establish the value of early integration. A well-known randomised trial in metastatic non-small-cell lung cancer found better quality of life and mood with early palliative care and less aggressive care near the end of life; that individual trial also observed longer median survival. However, broader systematic-review evidence has found only low-certainty evidence for small improvements in quality of life and symptom intensity and uncertainty about survival. You should therefore avoid turning one influential trial into a universal claim that palliative care prolongs life.

The 2024 American Society of Clinical Oncology guideline update recommends early specialist interdisciplinary palliative care alongside active treatment for people with advanced solid tumours and haematological malignancies, especially when physical, psychosocial, or spiritual distress is not adequately addressed.

This short Mayo Clinic video can be used to discuss why palliative medicine may be integrated with cancer care rather than reserved for the final stage.

The Interprofessional Team

Palliative care is fundamentally collaborative. A team may include physicians, nurses, pharmacists, social workers, psychologists, physiotherapists, occupational therapists, dietitians, speech and language therapists, chaplains or spiritual-care practitioners, care coordinators, support workers, volunteers, and others.

Physicians and advanced practice clinicians may assess diagnoses, prognosis, symptom mechanisms, treatment options, and medical decision-making. Nurses often provide continuous assessment, symptom monitoring, education, care coordination, and support to patients and families. Pharmacists contribute medication review, interaction checks, formulation and route advice, opioid stewardship, deprescribing, and medication safety. Social workers address family systems, practical needs, safeguarding, resources, and psychosocial distress. Psychologists and counsellors can support coping, mood, trauma, and adjustment. Rehabilitation professionals can help preserve function, safety, energy, communication, swallowing, and participation. Spiritual-care practitioners explore meaning, values, hope, faith, and existential distress when the patient wishes.

Interprofessional care works best when responsibilities are clear, information is shared, conflicting messages are addressed, and the patient's priorities remain central.

Holistic Clinical Assessment

A strong palliative assessment is structured but not mechanical. You can organise it around five questions:

Current problems: What symptoms, functional limitations, emotional concerns, practical problems, or caregiver issues are most important now?
Causes and reversibility: What is causing each problem, and which causes are reversible or modifiable?
Impact: How does the problem affect sleep, function, relationships, identity, cognition, and quality of life?
Goals and trade-offs: What outcomes matter most, and what burdens would the person accept for a possible benefit?
Reassessment: How will the team know whether the plan worked, caused harm, or needs revision?

Validated symptom and function tools can support assessment, but a scale never replaces clinical reasoning or conversation. A numerical pain score, for example, does not reveal the mechanism of pain, the person's coping, adverse effects, or what level of relief would be meaningful.

Function, Performance, and Prognosis

Function often provides important prognostic information, but prognostication remains uncertain. Clinicians may use performance scales and disease-specific information together with trajectory, nutritional changes, acute complications, and treatment response. A prognosis should usually be communicated as an estimate with uncertainty, not as a guaranteed date.

Useful communication includes explaining what is known, what is uncertain, and what changes would make the team revise its estimate. This prevents both false precision and avoidance of difficult information.

Communication in Serious Illness

Communication is a clinical skill. It influences understanding, trust, planning, symptom reporting, and the emotional experience of care.

Before giving information, ask what the person already understands and how much detail they want. Share information in manageable pieces, avoid jargon, and check understanding. One simple structure is ask–tell–ask: ask about the person's understanding, tell the relevant information clearly, then ask what they understood and what questions arise.

When discussing uncertainty, phrases such as "I am worried that..." can communicate concern without pretending to certainty. Empathic responses should acknowledge emotion before moving immediately to problem-solving.

Shared decision-making does not mean placing the entire burden of a complex medical choice on the patient. Clinicians should explain reasonable options, likely benefits and burdens, and make recommendations that are connected explicitly to the patient's goals and values.

The Stanford patient story above can support reflection on how serious illness affects identity, priorities, and the experience of care.

Goals of Care

A goals-of-care conversation is broader than asking whether a person wants cardiopulmonary resuscitation. It may explore:

Illness understanding: What does the person understand about the condition and what has the clinical team explained?
Values: What makes life meaningful, and what abilities or relationships are especially important?
Hopes and worries: What outcomes does the person hope for and what outcomes do they fear?
Trade-offs: What burdens or risks would be acceptable for a chance of achieving a valued outcome?
Recommendations: Which available treatments best fit the person's priorities in the current clinical situation?

Goals can change. High-quality care revisits them when the illness changes, after hospitalisation, when treatment options change, or when the patient asks to reconsider.

Symptom Management: A Reasoning Framework

For any symptom, begin with assessment rather than a reflex prescription.

First, define the symptom. Clarify onset, severity, pattern, triggers, relieving factors, associated features, and impact.

Second, consider causes. A symptom may have several causes at once. Breathlessness may arise from tumour burden, infection, fluid overload, anaemia, anxiety, deconditioning, or other processes.

Third, decide which causes should be treated. A potentially reversible cause may be worth treating when the likely benefit fits the patient's goals and the burden is acceptable.

Fourth, use non-pharmacological and pharmacological approaches when appropriate. The best plan often combines both.

Fifth, reassess. Check benefit, adverse effects, function, sedation, cognition, and whether the patient's priorities changed.

Pain

Pain should be assessed for mechanism, location, severity, temporal pattern, aggravating and relieving factors, function, previous treatment, and the patient's concerns. Nociceptive, neuropathic, visceral, bone, and mixed pain may require different strategies.

Opioids are important in palliative care, but safe opioid prescribing is individualised. Choice of drug, route, formulation, and dose depends on prior opioid exposure, pain pattern, organ function, swallowing, interactions, adverse effects, and clinical context. Conversion between opioids is a high-risk task that requires appropriate guidance and checking.

Common opioid-related adverse effects include constipation, nausea, drowsiness, and cognitive effects. Respiratory depression is a serious risk, especially with unsafe dosing or interacting sedatives. Fear of opioids should not prevent appropriate symptom relief, but confidence should not replace careful assessment and monitoring.

The image above is a transdermal fentanyl patch. It is included to illustrate that route and formulation matter. A patch is not simply interchangeable with oral medication, and transdermal opioids are not appropriate for every patient or every pain pattern. Follow current local guidance and specialist advice when needed.

Breathlessness

Breathlessness is both a physical sensation and an emotional experience. Assess reversible causes and the person's goals. Non-pharmacological approaches may include positioning, pacing, reassurance, airflow from a fan, relaxation, and rehabilitation strategies when appropriate.

Opioids can reduce refractory breathlessness in selected patients, but treatment must be individualised. Oxygen is clearly indicated for hypoxaemia in relevant clinical contexts but does not automatically relieve breathlessness in every non-hypoxaemic patient. Anxiety may amplify breathlessness, yet not all breathlessness is primarily anxiety.

Nausea, Vomiting, and Constipation

Nausea and vomiting require cause-based assessment. Potential contributors include medication effects, constipation, bowel obstruction, metabolic disturbance, intracranial disease, gastric stasis, infection, and anxiety. Antiemetic choice should reflect likely mechanism, interactions, adverse effects, and route.

Constipation is common in serious illness and may result from opioids, reduced intake, immobility, dehydration, metabolic problems, or bowel disease. Prevention and treatment should be proactive, especially when opioids are used, while recognising situations such as bowel obstruction in which standard strategies may be inappropriate.

Delirium and Agitation

Delirium is an acute disturbance of attention and cognition that often fluctuates. In palliative settings, causes may include infection, medication effects, organ failure, dehydration, metabolic disturbance, urinary retention, constipation, pain, and environmental factors.

Management begins by identifying causes that are both reversible and worth treating in the context of goals of care. Non-pharmacological measures can include calm orientation, familiar people, reduced unnecessary noise, attention to sensory aids, comfort, and sleep-wake cues. Medication may be needed for severe distress or risk, but treatment depends on clinical context and can itself cause unwanted sedation or adverse effects.

Fatigue and Weakness

Fatigue is multidimensional. Evaluate contributing factors such as anaemia, infection, medication effects, sleep disturbance, depression, pain, malnutrition, endocrine problems, and deconditioning when investigation is consistent with the goals of care.

Energy conservation, prioritisation, gentle activity when feasible, assistive devices, and treatment of relevant reversible causes may help. The aim is not always to maximise activity; it is to help the person use limited energy for what matters most.

Medication Review and Deprescribing

As illness advances, medications that were beneficial for long-term prevention may offer little near-term value or may create burden, interactions, monitoring requirements, or swallowing difficulty. Deprescribing is not abandonment. It is a structured review of whether each medicine still matches the patient's goals, prognosis, time to benefit, treatment burden, and risk.

At the same time, symptom-relieving medicines may become more important. The key question is not "How many medicines can be stopped?" but "Which medicines still provide meaningful benefit for this person now?"

Advance Care Planning and Decision-Making

Advance care planning involves discussing and preparing for future medical decisions, especially if a person later cannot communicate. It may include values, care preferences, a chosen surrogate decision-maker, and legally recognised advance directives. The exact legal status of documents and surrogate roles varies by jurisdiction.

Decision-making capacity is specific to the decision and may fluctuate. A diagnosis of dementia, mental illness, or serious physical illness does not by itself prove lack of capacity. When a patient lacks capacity, clinicians should follow applicable law and ethical standards, including valid advance directives and appropriate surrogate decision-making.

A do-not-attempt-resuscitation or do-not-resuscitate decision concerns cardiopulmonary resuscitation. It should not automatically mean "do not treat," "comfort care only," or withdrawal of all other interventions. Other treatments require their own clinical and ethical decisions.

Proportionality and Treatment Burden

A treatment can be medically possible yet still be disproportionate if its likely burdens greatly outweigh the chance of achieving an outcome the patient values. Proportionality requires clinical evidence, prognosis, patient goals, and uncertainty to be considered together.

Examples include repeated hospital transfers, intensive monitoring, invasive procedures, or treatment toxicities when the expected benefit is small. The same intervention may be proportionate for one person and not for another because goals, prognosis, and treatment response differ.

Palliative Sedation

Palliative sedation refers to the monitored use of sedating medication to reduce consciousness when necessary to relieve otherwise refractory suffering in a patient with life-limiting illness. It is a specialised intervention, not a routine response to distress.

The revised 2024 framework from the European Association for Palliative Care emphasises refractoriness of suffering, proportionality, patient autonomy, careful decision-making, and independent consideration of hydration. Palliative sedation is ethically and clinically distinct from using excessive medication without assessment, from routine symptom treatment that happens to cause drowsiness, and from intentionally causing death.

Because definitions, laws, medications, documentation requirements, and clinical protocols differ, palliative sedation should follow current specialist and institutional guidance.

Care in the Last Days of Life

Recognising that a person may be entering the last days of life can be difficult. Signs may include declining consciousness, reduced intake, worsening weakness, changes in breathing, reduced mobility, and social withdrawal, but none should be treated as a perfect predictor in isolation. Reassessment matters because some people stabilise or improve temporarily.

Care should focus on comfort, dignity, communication, family support, and an individualised plan. Review treatments that no longer provide benefit, anticipate likely symptoms, ensure appropriate routes for medication if swallowing becomes difficult, and explain what changes families may observe.

Hydration decisions should be individualised. Clinically assisted hydration may help some symptoms in some patients and may cause harms such as fluid overload. Evidence does not justify a universal claim that assisted hydration always prolongs life or always increases comfort in the last days of life.

Mouth and lip care, repositioning, quiet presence, attention to urinary retention or constipation, and clear explanations to family members can be clinically meaningful.

Family, Caregivers, and Bereavement

Palliative care treats the patient as the primary decision-maker when they have capacity while also recognising the needs of family and other important people. Caregivers may experience exhaustion, financial pressure, anticipatory grief, conflict, uncertainty, and fear of managing symptoms at home.

Support can include education, respite, practical planning, social work, psychological care, spiritual care, emergency contact plans, and bereavement follow-up. Clinicians should also ask who the patient considers family rather than assuming that legal or biological relationships capture all important relationships.

Culture, Spirituality, and Equity

Culture influences communication, family roles, beliefs about illness, decision-making, food, rituals, and care after death, but you should never use cultural background as a stereotype. Ask each person what matters to them.

Language access is a patient-safety issue. When discussing serious decisions, use qualified interpreters when needed rather than relying on children or untrained family members.

Structural inequities can affect who receives palliative care, when referrals happen, where services exist, whether medicines are available, and whether home care is feasible. Equity therefore requires more than respectful bedside communication; it also requires attention to service design, policy, disability access, rural access, poverty, racism, and other barriers.

Paediatric Palliative Care

Paediatric palliative care supports infants, children, young people, and families living with life-limiting or life-threatening conditions. It may begin at diagnosis and can accompany disease-directed treatment.

Developmental stage changes how symptoms, decision-making, communication, play, school, identity, and family support should be approached. Parents or guardians usually have major legal and caregiving roles, while the child's developing capacity, preferences, and participation should be respected according to age, maturity, clinical situation, and local law.

The Johns Hopkins Children's Center video above offers a patient- and family-centred view of paediatric palliative care.

Evidence-Based Palliative Care

Evidence in palliative care includes randomised trials, systematic reviews, observational studies, qualitative research, implementation research, guidelines, patient-reported outcomes, and ethical analysis. Outcomes often include quality of life, symptom burden, mood, communication, caregiver experience, healthcare use, place of care, and survival.

When reading evidence, ask whether the participants resemble the population you care for, whether the intervention was specialist or generalist palliative care, what usual care contained, how outcomes were measured, whether missing data may bias results, and whether benefits are clinically meaningful.

Avoid interpreting "no statistically significant difference" as proof that two approaches are identical. Also avoid treating a statistically significant result as automatically important to patients.

Selected Evidence and Guidelines

World Health Organization: Palliative care: Definition, global need, interdisciplinary care, and the role of early palliative care.
NICE guideline NG31: Care of dying adults in the last days of life: Recognition, communication, shared decision-making, hydration, symptom management, and anticipatory prescribing.
ASCO guideline update on palliative care for patients with cancer: Evidence-based recommendations for integration with oncology.
Temel and colleagues: Early palliative care for metastatic non-small-cell lung cancer: Influential randomised trial on quality of life, mood, end-of-life care, and survival.
Cochrane review: Early palliative care for adults with advanced cancer: Systematic review highlighting small possible benefits and uncertainty in several outcomes.
Revised EAPC framework on palliative sedation: Consensus-based guidance on refractoriness, proportionality, autonomy, and clinical decision-making.
National Institute on Aging: Advance care planning: Accessible explanation of future care discussions and advance directives.

Applied Case Study

A 69-year-old university librarian has advanced heart failure, chronic kidney disease, recurrent hospital admissions, breathlessness on minimal exertion, poor sleep, and increasing dependence on a partner. The cardiology team is considering another hospital-based intervention. The patient says, "I want more time if treatment can help me stay at home, but I do not want to spend whatever time I have left going in and out of hospital."

A palliative approach would not begin by deciding for or against the intervention. It would first clarify the patient's understanding, likely benefits and burdens, uncertainty, symptom mechanisms, home support, caregiver capacity, and what "staying at home" means in practical terms. The team could then make a recommendation connected to these priorities.

Ask yourself: Which symptoms need assessment now? Which reversible causes are worth investigating? What information is necessary for an informed decision? Which professionals should be involved? How would your recommendation change if the intervention had a high chance of improving function for six months? How would it change if the chance of meaningful benefit were very low and the treatment required prolonged hospitalisation?

Interactive Tasks

Quiz: Test Your Knowledge

Which statement best describes palliative care? (It aims to improve quality of life and relieve suffering during serious illness) (!It is provided only when curative treatment has stopped) (!It is limited to cancer during the final days of life) (!It always requires admission to a hospice)

What is the best first step when managing a new distressing symptom? (Assess the symptom and consider its likely causes) (!Start the strongest available medicine immediately) (!Avoid asking about the impact on function) (!Assume the symptom is caused by the underlying diagnosis)

Which statement about hospice and palliative care is most accurate? (Palliative care is broader and hospice eligibility varies by health system) (!Hospice and palliative care always mean exactly the same thing) (!Palliative care begins only after hospice discharge) (!Hospice rules are identical in every country)

What is a central feature of shared decision-making? (Connecting treatment options and recommendations to the patient's goals) (!Leaving all medical interpretation to the patient) (!Avoiding discussion of uncertainty) (!Using family preferences instead of the patient's wishes)

Which statement about opioid use in palliative care is correct? (Opioid therapy requires individualised assessment and monitoring) (!All opioid formulations can be exchanged without calculation) (!Transdermal fentanyl is suitable for every opioid naive patient) (!Opioids never cause clinically important adverse effects)

Which description best fits delirium? (An acute and often fluctuating disturbance of attention and cognition) (!A stable personality trait that does not change) (!A symptom that is always caused by psychological stress) (!A diagnosis that never requires assessment for reversible causes)

What does advance care planning primarily support? (Preparation for future healthcare decisions and communication of values) (!Automatic refusal of all life sustaining treatment) (!Replacement of current consent when a patient has capacity) (!One universal legal document used in every country)

Which statement about a do not resuscitate decision is correct? (It concerns cardiopulmonary resuscitation and does not define all other treatment) (!It automatically stops every medication and investigation) (!It is identical to a request for palliative sedation) (!It means that comfort measures should not be offered)

When is palliative sedation considered in specialist practice? (When otherwise refractory suffering requires proportionate reduction of consciousness) (!Whenever a patient reports any mild symptom) (!As a routine substitute for communication) (!To intentionally cause death)

What is the best interpretation of evidence on early palliative care? (It may improve quality of life while effects vary across studies and populations) (!It proves that palliative care always prolongs survival) (!It shows that palliative care has no role during active treatment) (!It applies only to one cancer diagnosis)

Memory Game

Palliative care	Care focused on quality of life and relief of suffering in serious illness
Delirium	Acute fluctuating disturbance of attention and cognition
Deprescribing	Planned review and stopping of medicines that no longer offer sufficient benefit
Autonomy	Respect for a person's informed choices and values
Dyspnea	Subjective experience of difficult or uncomfortable breathing
Bereavement	Period of grief and adjustment after a death
Refractory symptom	Distress that cannot be adequately relieved by acceptable available treatment

Drag and Drop

Match the correct terms.	Topic
Explores what outcomes matter most to the patient	Goals of care
Reviews whether long term medicines still provide meaningful benefit	Deprescribing
Uses several professions to address complex needs	Interprofessional care
Prepares for future decisions if communication becomes impossible	Advance care planning
Addresses physical psychological social and spiritual distress	Holistic assessment

...

Crossword Puzzle

Hospice	What model of care commonly focuses on people approaching the end of life?
Dyspnea	What one-word clinical term means difficult or uncomfortable breathing?
Delirium	What acute fluctuating cognitive syndrome is common in serious illness?
Autonomy	What ethical principle concerns respect for informed personal choice?
Bereavement	What term describes grief and adjustment after a death?
Refractory	What word describes suffering that cannot be adequately relieved by acceptable available treatment?

LearningApps

Cloze Text

Palliative care aims to improve

for people living with serious illness and those important to them. It can be integrated with

rather than being reserved for the final days of life. A holistic assessment includes physical symptoms as well as psychological, social, practical, and

concerns. Good symptom management begins with careful

before treatment is selected. Shared decision-making connects clinical options with the patient's

. Advance care planning helps prepare for future decisions if a person loses the ability to

. A do-not-resuscitate decision concerns

rather than every possible treatment. Delirium is often acute and

. Palliative sedation is reserved for otherwise

suffering and requires proportionate specialist practice. High-quality care depends on repeated

because symptoms, goals, and clinical conditions can change.

Open-Ended Tasks

Easy

Palliative care concept map: Create a one-page concept map that shows how physical, psychological, social, spiritual, and practical needs can influence one another in serious illness.
Communication reflection: Write 400 words comparing a disease-centred consultation with a person-centred palliative care consultation, using two concrete examples.
Media analysis: Choose one image or video in this course and explain what it teaches well, what it leaves out, and what assumptions a viewer should question.
Public information leaflet: Design a clear one-page leaflet for patients that corrects three common misconceptions about palliative care without using technical jargon.

Standard

Interprofessional case conference: In a small group, assign professional roles and create a coordinated care plan for the applied heart-failure case, showing who will do what and why.
Symptom assessment interview: Conduct a simulated interview about breathlessness or pain, record it with consent, and evaluate whether your questions covered causes, impact, goals, and reassessment.
Advance care planning interview: Interview a willing adult about how people should prepare for future healthcare decisions, avoiding requests for private medical details, and compare the themes with a trusted advance-care-planning resource.
Service visit: Visit or virtually tour a hospice, palliative care unit, or home-care service and produce a structured report on access, team roles, continuity, and patient-family support.

Advanced

Evidence appraisal: Critically appraise the Temel trial and the Cochrane review, then explain why their conclusions about early palliative care should not be treated as identical.
Ethics simulation: Create and perform a video simulation in which a team discusses a high-burden treatment with a patient whose priority is remaining at home, then analyse autonomy, proportionality, uncertainty, and recommendation-making.
Equity audit: Design a small audit or research proposal examining one barrier to palliative care access in your region, including population, outcome measures, ethical considerations, and a feasible improvement strategy.
Palliative sedation seminar: Prepare a university seminar comparing proportionate palliative sedation with routine symptom treatment, unintended medication sedation, and intentionally causing death, using current professional guidance and local law.

Learning Assessment

Integrated case analysis: Analyse a complex serious-illness case by linking symptom mechanisms, functional status, goals, treatment burden, caregiver needs, and an interprofessional plan.
Communication OSCE: Conduct a simulated serious-illness conversation in which you assess understanding, discuss uncertainty, respond to emotion, elicit values, and make a goal-concordant recommendation.
Evidence transfer: Use one palliative care guideline and one research study to justify a clinical approach while identifying at least two limits to applying the evidence to a different patient population.
Ethical reasoning: Evaluate a disagreement about life-sustaining treatment using capacity, autonomy, surrogate decision-making, proportionality, relevant law, and the distinction between withholding and abandoning care.
Medication review: Review a fictional medication list for a patient with advanced illness and explain which medicines require continuation, modification, closer monitoring, or possible deprescribing without calculating individual doses.
Service design: Propose a palliative care pathway for a university hospital that improves referral timing, language access, caregiver support, continuity across settings, and measurable quality outcomes.

Evidence of Learning

Important evidence of learning includes knowledge of palliative care principles, illness trajectories, symptom frameworks, communication, ethics, and evidence quality; clinical reasoning skills that connect causes, goals, benefits, burdens, and reassessment; communication skills that make uncertainty understandable and respond to emotion; teamwork skills that coordinate contributions across professions; and ethical reasoning that respects autonomy while recognising capacity, law, proportionality, and uncertainty.

Useful products include a concept map, patient information leaflet, case conference plan, recorded simulation, evidence appraisal, service report, equity audit proposal, and structured care pathway. Strong transfer is shown when you can apply palliative principles to illnesses other than cancer, to different cultural and health-system contexts, and to changing stages of disease without treating palliative care as synonymous with imminent death.

OERs on the Topic

Additional freely accessible learning and reference resources include the World Health Organization palliative care fact sheet, the NICE guideline on care of dying adults in the last days of life, the National Institute on Aging resource on advance care planning, and the Wikimedia Commons palliative care collection.

The Stanford patient story above can be used for further discussion of lived experience, goals, and quality of life.

Linked Learning Areas

Palliative Care

Palliative care connects biomedical science with ethics, psychology, sociology, communication, law, health-services research, rehabilitation, pharmacology, and public health. At university level, the topic is especially suitable for interprofessional learning because decisions are rarely solved by one discipline alone.

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