ICGP Logo
user
ICGP Logo

Palliative Care & End of Life Care (PA)

  • Palliative care is the care of people with life-limiting, progressive illness, and provides a comprehensive approach to the assessment and management of patients physical, psychological, social and occupational, and spiritual needs. Palliative care is provided by healthcare professionals in all settings.   

    Palliative care  is an important aspect of general practice, rooted in the principles of compassion, dignity, and person-centred care. GPs play a central role in supporting patients and their families through the final stages of life, whether care is delivered in the home, in residential settings, or alongside specialist palliative services. This care involves not only the management of physical symptoms, but also attention to emotional, psychological, spiritual, and social needs.    

    Effective palliative care relies on sensitive communication, advance care planning, and collaborative, multidisciplinary working. GPs are uniquely placed to provide continuity, coordinate care, and advocate for the wishes and priorities of patients as they approach death. Understanding the legal, ethical, and cultural aspects of dying, as well as recognising the importance of bereavement support, is essential to delivering high-quality care. As the population ages and more people choose to die at home, the GP’s role in providing compassionate, holistic end of life care is more important than ever.    

    The Professional Standards Statements in Palliative Care and End of Life Care have been structured under the 6 domains of competence as set out by the Palliative Care Competency Framework, 2014, a framework that outlines the core competencies in palliative care and was developed to provide consistency in education of palliative care in Ireland across health and social care professionals.  

    The Domains of Competence are: 

    1. Principles of Paliative Care 
    2. Communication 
    3. Optimising Comfort and Quality of Life 
    4. Care Planning and collaborative practice 
    5. Loss, Grief and Bereavement  
    6. Professional and ethical practice in the context of palliative care  

  • Principles of Palliative Care 

    • PA1. Explore and describe approaches to optimising prognosis in end-of-life care, including the use of appropriate clinical tools such as the SPICT tool. 
    • PA2. Provide effective palliative care for patients with advanced life-limiting illnesses, regardless of diagnosis, and recognise when and how to involve Specialist Palliative Care services. 

    Communication 

    • PA3. Explore how to successfully incorporate end of life planning into routine clinical care within the general practice setting with individuals and their households.  
    • PA4. Explore the statutory and legal roles of the Decision Support Service, including the types  of decision support arrangements that are possible (decision-making assistant, co-decision makers and decision-making representatives), advance healthcare directives, Enduring Power of Attorney (EPOA), and understand how to recognise, respond to, and incorporate these roles appropriately in clinical practice.  
    • PA5. Assess the needs of patients approaching end of life, conducting appropriate investigations and prioritising care based on patient values and preferences. 
    • PA6. Develop and implement individualised care plans that incorporate patient preferences, legal and ethical considerations, and advance care planning, while anticipating and addressing risks to continuity and decision-making, particularly in out-of-hours settings.  
    • PA7. Describe the key principles of end-of-life planning and care, including effective consultation skills, the application of the Assisted Decision-Making (Capacity) Act 2022, including the role of advance directives, and designated healthcare representatives, and the use of tools such as Think Ahead to support individuals and their households where appropriate.    
    • PA8. Communicate effectively with patients and their families, fostering shared decision-making and providing clear explanations about treatment options and prognosis. 
    • PA9. Demonstrate competence in breaking bad news and discussing poor outcomes with patients, families, and care providers.   
    • PA10. Adopt a patient-centred and compassionate approach to palliative care, addressing the unique needs of dying patients and their families while fostering a supportive and inclusive environment.  

    Optimising Comfort and Quality of Life 

    • PA11. Manage medications in palliative care, including drug conversion, appropriate administration, monitoring for side effects, and optimising treatment outcomes. 
    • PA12. Recognise and manage distressing symptoms in palliative care.  
    • PA13. Describe palliative care emergencies and their appropriate management.  

    Care Planning and Collaborative Practice 

    • PA14. Provide holistic care that considers the psychosocial, spiritual, and cultural needs of patients and their families, recognising the importance of dignity at the end of life.   
    • PA15. Coordinate palliative care effectively, collaborating with other healthcare professionals and utilising available resources to ensure high-quality end-of-life care.  

    Loss Grief and Bereavement 

    • PA16. Demonstrate knowledge and competence in supporting grieving, including normal and abnormal grief reactions, and cultural nuances in these areas of care.  

    Professional and Ethical Practice in the context of Palliative Care 

    • PA17. Manage patient confidentiality and information sharing in the context of palliative care, ensuring ethical and legal compliance.   
    • PA18. Consider the legal and ethical aspects of palliative care, including obtaining consent, managing death certification including liaising with the coroner where appropriate or necessary, and adhering to ethical principles. 
    • PA19. Demonstrate self-awareness, adaptability, and resilience in palliative care, recognising the challenges of working with dying patients and their families 
    • PA20. Stay up to date with the latest evidence and best practices in palliative care, acknowledging the challenges of limited clinical trials in this field and engaging in ongoing professional development.  

    Signs, Symptoms & Presentations

    • Anorexia  
    • Ascites  
    • Breathlessness 
    • Cachexia  
    • Complex Grief 
    • Constipation
    • Excessive Secretions 
    • Fatigue  
    • Headaches  
    • Hiccups  
    • Limb Weakness 
    • Nausea  
    • Pain 
    • Psychological Distress 
    • Restlessness 
    • Seizures  
    • Terminal Agitation 
    • Vomiting  

    Common and Important Conditions

    • Complications of treatment  
    • Emergencies in palliative care: 
      • Haemorrhage 
      • Hypercalcemia  
      • Pancytopenia 
      • Raised Intracranial Pressure 
      • Sepsis  
      • Spinal Cord Compression 
      • Superior Vena Cava Obstruction  
    • Recognition and management of the final stages of life (anticipatory prescribing) 
    • Thromboembolic Events  

  • Wherever possible learning resources included here are peer reviewed and externally maintained. This is to ensure that trainees have access to quality assured information that is kept up to date.

    Self-Directed 

    Blended Learning Resources (Education Platform)

    Dying, Death and Bereavement

    Workplace Based Learning

    Workplace-based learning in palliative care offers GP trainees valuable, hands-on experience in supporting patients with life-limiting illness across both community and specialist settings. In general practice, trainees learn to recognise when a patient is entering the end of life phase, initiate sensitive conversations about prognosis and goals of care, and coordinate multidisciplinary input. They also gain experience in symptom management, community palliative care, anticipatory prescribing, and supporting families through bereavement. In palliative medicine placements, trainees deepen their understanding of complex symptom control, holistic assessment, and ethical decision-making. Learning is enriched through case-based discussions, joint home visits, hospice exposure, and reflective practice, helping trainees to develop confidence, compassion, and competence in delivering high-quality palliative care.

    Day Release

    Day release teaching offers a valuable opportunity to explore palliative care in a reflective and supportive environment. These sessions allow GP trainees to deepen their understanding of key topics such as advance care planning, recognising dying, communication with patients and families, symptom control, and ethical issues in palliative care. Using case-based discussions, role play, and peer reflection, trainees can build confidence in managing difficult conversations and decision-making at the end of life. Guest input from palliative care specialists, nurses, or bereavement counsellors can offer additional insights and highlight the importance of a multidisciplinary approach. Day release also provides space to reflect on the emotional impact of this work and develop strategies for self-care and resilience.

    Registrar Tutorials

    Registrar tutorials provide an ideal setting for in-depth learning and discussion around palliative care, tailored to the needs of GP trainees. These sessions can focus on practical and sensitive topics such as recognising when a patient is approaching the end of life, advance care planning, symptom management (including pain, nausea, and breathlessness), and communication with patients and families. Tutorials also offer space to explore ethical dilemmas, cultural considerations, and the GP’s role in coordinating care with palliative teams and community services. Real cases, guideline reviews, and role-playing scenarios can help build confidence and empathy, while also encouraging reflection on the emotional impact of providing palliative care.

  • Entrustable Professional Activities (EPAs) underpin workplace-based assessment in this curriculum. Each EPA represents an integrated clinical task that General Practitioners must perform safely and independently, assessed through direct or indirect observation in real clinical settings.

    The curriculum and EPA framework are closely aligned: the curriculum defines the required knowledge, skills, and professional behaviours, while EPAs assess their application in practice. Together, they create a coherent approach to developing and demonstrating readiness for independent clinical work.

    The examples show how specific activities within general practice & chapters of the curriculum align with particular EPAs.

     EPA 15: Care of a patient with a life-limiting illness, palliative care, and end-of-life care needs

    A patient with advanced heart failure presenting for a care planning discussion provides an opportunity to demonstrate EPA 15. If the GP Trainer observes the consultation, a PIP-C can be used to assess sensitive exploration of prognosis, advance care planning using tools such as Think Ahead, and discussion of legal considerations including Enduring Power of Attorney. A succinct case entry could be: “advance care planning discussion in end-stage heart failure.” Reflection should explore strategies for shared decision-making, maintaining dignity, and addressing cultural and spiritual needs in end-of-life care.

    Core Knowledge Test (CKT)

    • Choosing the most appropriate opioid for pain in renal failure
    • Management of refractory breathlessness in a palliative patient
    • Advance Care Planning

    Clinical Competency Test (CCT)

    • You are asked to break bad news to a patient about their latest scan results.
    • A patient with a diagnosis of Dementia attends to discuss advanced care planning.
    • A patient with a diagnosis of heart failure is struggling with symptoms and presents to you for some advice. 

    Disclaimer: The examples provided within this section are intended to be indicative only and are included to illustrate how elements of the curriculum may be assessed in the Clinical Competency Test (CCT).

    Examination questions in the CCT test the ability of candidates to integrate knowledge, skills, and professional behaviours across multiple curriculum areas to address the challenges posed by the question.

    The indicative content should therefore be used solely as a general guide as to some of the topics that may be introduced. Actual examination questions will assess a greater depth and complexity of understanding than the illustrative examples provided.

    Please note that a number of CCT questions will require candidates to undertake a physical examination of the simulated patient. In some circumstances, for example in the case of an intimate examination, candidates may be required to display their examination skills through use of a manikin or other device.