•    Communication:

o    SPIKES model:

    Set up the interview.

    Perception — check patient’s understanding.

    Invitation — how much do they want to know?

    Knowledge — share information clearly and in small chunks.

    Empathy — respond to emotions.

    Strategy and summary — plan together.

o    Important to avoid medical jargon and allow silence.

•    Capacity:

o    Patients must understand, retain, weigh, and communicate a decision.

o    Presumed to have capacity unless proven otherwise.

o    Capacity is decision- and time-specific.

•    Advance care planning:

o    Includes discussing:

    Preferred place of care and death.

    DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) orders.

    Advance decisions to refuse treatment (ADRT).

    Lasting power of attorney (LPA) for health and welfare.

Extra Revision Pearls

•    Terminal agitation: may require benzodiazepines (e.g., midazolam SC).

•    Anticipatory (just-in-case) medication: includes morphine, midazolam, glycopyrronium, haloperidol.

•    Opioid-induced hyperalgesia: consider reducing dose or rotating opioid.

•    When converting between opioids: reduce dose by 30% to account for incomplete cross-tolerance.

•    Bowel regimens: always prescribe prophylactic laxatives with opioids.

•    Family education: explain signs of imminent death (e.g., reduced intake, Cheyne-Stokes breathing, cool extremities).

•    Doctrine of double effect: giving medication with the intention of symptom relief is ethically acceptable even if life-shortening.