Consider consult to Palliative Care Team for complex
symptom management issues
• Initiate other interdisciplinary referrals
• Customize a plan of treatment that is flexible and aims
to:
• address the identified symptoms
• respect the person’s choices
• respect the person’s culture, values, beliefs,
personality and preferences
• support the desire for control, independence,
intimacy and sense of dignity for as long as
possible
• proactively address emergent issues (e.g. who
to call, what to do, escalating symptoms)
• anticipates potential complications
• Adjust the care plan to individual need (e.g., turn q2h
only if tolerated, frequent mouth care, supportive
surfaces)