Introduce paediatric palliative care and refer at diagnosis — OSCE

Candidate brief

You have this station to introduce paediatric palliative care to the parents of a 6-year-old newly diagnosed with relapsed high-risk neuroblastoma, correct the misconception that palliative care means giving up, explain the parallel-care model and what the team will do, and make the referral. Treat this as a communication and decision-making encounter: acknowledge the family's fear, reframe palliative care as an added layer that runs alongside cancer treatment, name the four domains of suffering, and demonstrate that the palliative referral and any resuscitation decision are separate. [4] [5]

Key teaching and management objectives

Begin by acknowledging the fear and correcting the misconception directly. The parents have heard "palliative" as a synonym for giving up. State plainly that palliative care is not about stopping treatment: it is a layer of care added on top of the cancer treatment, with the goal of relieving suffering and supporting the whole family from now onward. The World Health Organization defines it as the active total care of the child's body, mind and spirit, and the support of the family, from diagnosis onward — and it runs in parallel with disease-directed therapy, regardless of whether curative treatment continues. [5] [1]

Frame the timing. Referring at diagnosis is the standard, not a sign of pessimism. The evidence is Wolfe's two cohorts: in 2000, children who died of cancer suffered substantially, and by 2008 earlier palliative involvement was associated with reduced suffering. The lesson of that evidence is to involve the team while curative treatment is still active. The child fits Together for Short Lives group 1 (curative treatment may fail), and the referral belongs at diagnosis so that palliative care is already in place if the curative path fails. [1] [2] [10]

Describe what the team will do across the four domains of suffering: the physical (pain and symptom control, alongside oncology), the psychological (the child's fears and the family's coping), the social and family (school, siblings, finances, practical support), and the spiritual or existential (what gives the family's life meaning, their hopes). Explain that the family is the unit of care, and that the multidisciplinary team — physician, nursing, social work, psychology, chaplaincy, child life — will support them, not replace the oncology team. [4] [5]

Address the resuscitation question if it arises. Make clear that the palliative referral does not change the resuscitation or escalation status, and that the two are separate decisions: a child can continue full escalation and still benefit from palliative care, and any limitation decision would be a separate, careful best-interests conversation. Elicit and document the preferred place of care and the after-hours support, so that a future crisis does not catch the family without a plan. [4] [11]

Close by naming the bereavement follow-through as part of the service, not an afterthought: the team will stay with the family through whatever the illness brings, and through bereavement afterwards, with follow-up of parents and siblings. [4] [11]

Marking domains

• Acknowledging fear and correcting the misconception (4 marks). Names the fear, reframes palliative care as an added parallel layer rather than stopping treatment, and states the WHO definition and the parallel-care model accurately.
• Explaining timing and the evidence (3 marks). Defends referral at diagnosis, cites the Wolfe evidence that earlier palliative involvement reduced suffering, and places the child in Together for Short Lives group 1.
• The four domains and the family as unit of care (2 marks). Names the physical, psychological, social and spiritual domains; describes the multidisciplinary team and the family-centred approach.
• Separating the referral from the resuscitation decision, and the bereavement pathway (1 mark). Clarifies that the palliative referral does not change escalation status; documents preferred place of care and names bereavement follow-through as a core deliverable. [1] [4] [11]