1. Basics, definitions, organizational structure in the Czech Republic

a. Definition, history and evidence. General and specialized care, multidisciplinary approach.

b. Forms of provision of palliative care (depending on the place of provision: hospice, home specialized PP, hospital counseling team, outpatient PP, stationary, respite stays)

c. Children's palliative care

d. Options for providing care to geriatric patients (general, specialized, non-medical)

2. Interdisciplinary cooperation, coordination of care

a. Interdisciplinary assessment and communication with the doctor of the basic field

b. Indication of terminal palliative care, application to hospice

c. Hospital palliative care - early intervention, request for a consultation of a palliative physician and a geriatrician

3. The needs of patients with serious illness and in geriatrics

a. The most common symptoms of a serious illness

i. pain: acute, chronic, breakthrough

ii. GIT: damage and infection of the oral cavity, dysphagia, constipation, diarrhea, ileus, nausea, vomiting, intestinal obstruction

iii. pulmonary: shortness of breath, cough

iv. nutrition and fluids: nutritional support, anorexia, cachexia, thirst, sub/dehydration

v. skin: pruritus, intertrigo, decubitus and chronic wounds

vi. neuropsychiatric, neurodegenerative: cognitive disorders, delirium, confusion, insomnia, depression, anxiety, fear, communication and mobility disorders due to impaired sensory, motor or executive speech functions

vii. venous access: possibilities, limitations and advantages

viii. ostomies, catheters and drains: importance and risks

ix. other: hypercalcemia, spinal cord compression, intracranial hypertension syndrome, anemic syndrome, fevers, pathological fractures, etc.

b. Specifics of the geriatric patient

i. characteristics of organism aging, polymorbidity, chronicity, polypragmasia, fragility, renal and hepatic dysfunction, nutrition

ii. restriction of physical activity, osteoporosis (prevention and complications), arthrosis, degenerative diseases of the spine, joint replacements,

iii. cognitive and neuropsychiatric changes, problems of care for patients with cognitive disorders and differentiation of communication and movement disorders due to sensory, motor or executive speech function disorders

c. Psychological needs

i. hierarchy of patient needs (Maslow's pyramid)

ii. orientation in the trajectory of the disease

iii. adaptation to illness, emotions

iv. grief and mourning (child as survivor)

d. Social needs

i. orientation in the social support system (patients and caregivers/parents)

ii. social ties, social role of the patient, caregivers and loved ones

e. Spiritual needs

i. Hope, faith, meaning of life, religious belief

ii. Spiritual needs of a non-religious nature, traditions, rituals, a sense of wholeness, completion

f. Care of the dying - picture and management of terminal symptoms, including intensive care

4. Communication with a focus on emotions in the doctor - patient - closed people relationship

a. communication of unfavorable news incl. pediatric issues

b. interview about prognosis

c. communication about a reasonable and realistic goal of treatment

d. conflicts - prevention and resolution

e. family conference

5. Ethical and legal context of providing palliative care

a. legal norms in relation to palliative care

b. recommended procedures in pediatrics and adult patients

c. ethical aspects: palliative sedation, euthanasia, assisted suicide

6. Deciding on the Adequacy of Treatment

a. the patient's values and preferences, previously expressed wishes

b. a close person and a person with the right of proxy consent for patients who are not competent

c. treatment goal and therapeutic balance, procedure alternatives and their documentation

d. prognostic uncertainty Practical exercises, seminars: practical solutions for selected symptoms (e.g. pain, shortness of breath, malnutrition, disorientation, agitation), long-term intensive care unit, geriatric unit, hospice.