Palliative Care — Updates Since 2020

Housekeeping note: this category was renamed from “Aged Care & Palliative” to Palliative Care. common-clinical-conditions-in-aged-care.md (multimorbidity, deprescribing) moved to general-medicine.

Guideline & practice changes since 2020

• A 2024 RCT found no benefit to mechanism-based antiemetic selection over empiric first-line haloperidol for nausea/vomiting in advanced cancer. See Gastrointestinal Symptoms in Palliative Care.
• Methylnaltrexone is now available for refractory opioid-induced constipation once standard laxatives fail. See Gastrointestinal Symptoms in Palliative Care.
• Opioids for COPD-related breathlessness are now reserved for patients with limited other options, following an RCT showing sustained-release morphine ineffective in this specific context. See Respiratory Symptoms in Palliative Care.
• Palliative sedation — a defined third-line intervention, ethically and legally distinct from euthanasia/physician-assisted suicide. Indications (refractory + intolerable symptoms, <2 weeks prognosis), typical drug choices, and the GP’s usual recognise-and-refer role. See Terminal Care.
• The National Core Community Palliative Care Medicines List (2025) standardises four medications for community anticipatory prescribing. See Terminal Care.

New content added

• Depression & Psychological Distress in Advanced Illness — excluding biological mimics first, why routine screening isn’t recommended in this population, tamoxifen-interaction antidepressant choices, and the “time toxicity” concept for weighing non-pharmacological interventions.
• Diabetes & Chronic Disease Management in Advanced Illness — glucose target ranges by prognosis timeframe, which diabetes medications to stop first vs continue longest, and the beta-cell-burnout/type 3c diabetes exception.

New pages added

• Advance Care Planning & Substitute Decision-Making — NSW advance care directive validity criteria, the Person Responsible hierarchy under the Guardianship Act NSW (1987), how an Enduring Guardian differs from an Enduring Power of Attorney, NSW Health Resuscitation Plans, and practical triggers/conversation structure for the GP to raise advance care planning.