See validated screening tools mentioned in Principle 4 ‘Supportive care’.

A number of specific challenges and needs may arise for patients at this time:

• assistance for dealing with emotional and psychological distress from anticipatory grief, fear of death or dying, anxiety/depression and interpersonal problems
• communication difficulties
• management of physical symptoms including pain, dysphagia, fungating wounds, malnutrition and lethargy
• bleeding, which may be catastrophic (specialist interventional radiologist assessment should be considered)
• support for upper airway obstruction
• speech pathology management of swallowing difficulties
• management from dietitians with expertise in feeding via gastrostomy or a nasogastric tube
• decline in mobility or functional status, affecting the patient’s discharge destination (a referral to physiotherapy, exercise physiology, occupational therapy or social work may be needed)
• specific support for families where a parent is dying and will leave behind bereaved children or adolescents, creating special family needs
• appointing a substitute decision-maker and completing an advance care directive
• legal issues (completing a will, care of dependent children) and making an insurance, superannuation or social security claim on the basis of terminal illness or permanent disability
• arranging a funeral.

These services and resources can help:

• referral to 13 11 20 for Cancer Council Australia’s Pro Bono Program for free legal, financial, small business accounting and workplace assistance (subject to a means test)
• Sad news sorry business (Queensland Health 2015) for the specific needs of Aboriginal and Torres Strait Islander people.

For more information on supportive care and needs that may arise for different population groups, see Appendices A and B, and special population groups.

The lead clinician is responsible for:

• being open to and encouraging discussion with the patient about the expected disease course, considering the patient’s personal and cultural beliefs and expectations
• discussing palliative care options, including inpatient and community-based services as well as dying at home and subsequent arrangements
• providing the patient and carer with the contact details of a palliative care service
• referring the patient to palliative care in the community according to the carer’s wishes.

The lead clinician should discuss end-of-life care planning to ensure the patient’s needs and goals are met in the appropriate environment. The patient’s general practitioner should be kept fully informed and involved in major developments in the patient’s illness path.

For support with communication skills and training programs, see these sources:

• Sad news sorry business
• Principle 6 ‘Communication’