Palliative care in cancer — formative SAQs

SAQ 1 (10)

An eight-year-old girl with relapsed medulloblastoma is admitted with a severe pain flare, her parents exhausted after months of treatment and frightened by her deterioration. The oncology team is weighing another line of disease-directed therapy against the burden it will bring. [2] [4]

a) Give the World Health Organization consensus definition of palliative care, and explain why the integrated concurrent model that runs the palliative care alongside the disease-directed therapy is preferred to the sequential model that defers it to the moment the curative treatment fails. (3 marks) [1][2]

b) Outline the structured symptom assessment you would perform across the four dimensions of suffering, naming the validated tools you would use and the place of the family's proxy report. (3 marks) [4][2]

c) The child's pain is uncontrolled. State the principles of the World Health Organization analgesic ladder, how you would calculate the breakthrough opioid dose from the background, and the circumstances and the method for an opioid rotation. (2 marks) [3]

d) Outline the goals-of-care and advance care planning conversation you would hold with the family at this turning point, and the documents that would carry the plan. (2 marks) [2][6]

SAQ 2 (10)

A sixteen-year-old boy with refractory acute leukaemia and a failed stem-cell transplant is now in the last weeks of life, cared for at home with the community palliative team. His parents are exhausted and his twelve-year-old sister has become withdrawn and is refusing to go to school. [4] [5]

a) Outline the anticipatory medicines you would prescribe for the last days of life, naming the symptom each is intended to control, and explain how you would explain them to the family. (3 marks) [4]

b) Explain how the place-of-care and location-of-death decision between the home, the hospital and the hospice is made with the family, and why the achieved location often differs from the preference. (3 marks) [6]

c) Describe the bereavement-risk assessment and the structured follow-up you would offer the parents, and explain why the complicated grief is screened for and treated. (2 marks) [5]

d) Outline the sibling support you would offer the twelve-year-old sister, and the school and the peer measures that reduce the complicated grief. (2 marks) [5]