qathet Division of Family Practice

Palliative Resource Binder

Last update: May 2017


0.a. Palliative Binder Table of Contents
0.b. 2016 April SC Patient Letter Resource Binder
1. Palliative Binder Table of Contents with Suggested Time of Use
2. Palliative Care Referral Process


Tools for physicians, nurse practitioners and nurses to have “The Conversation”

3. Scripted Questions for ACP – PSP
4. ACP Requirements Cheat Sheet
5. The Conversation Starter Kit Booklet incl. Canadian legal addition
6. How to Talk to Your Doctor – TCP
7. RA7 Form – Nidus Rep Agreement
8. RA9 Form – Nidus Rep Agreement


Benefits applications and assessments to communicate patient status

9. SPICT Form – BC Palliative Benefits Registration
10. PPS – Palliative Performance Scale – Version 2 – Powell River
11. ESAS – Edmonton Symptom Assessment System
12. Medical Certificate for EI Compassionate Care Benefits – Service Canada
13. NO CPR – Bi Cardiopulmonary Resuscitation – BC Ambulance
14. Notification of Expected Death at Home
15. Red Cross Help Loan Form
16. Inter-Professional Checklist and Discharge Meeting
17. Standing Home Order – EoL
18. Appendix B – Constipation – Medications Used in Palliative Care
19. Bowel Management Guidelines


Supportive information to use at various times in the palliative journey

20. Symptom Management Handout – VCH
21. When Death is Close at Hand – VCH
22. Helping Children Cope with Death – VCH
23. Dehydration at the End of Life – VCH
24. What to Do When Someone Dies – VCH
25. Preparing for the Death of a Loved One – VCH
26. After Hours Palliative Nursing Service – VCH
27. If You Want to Die at Home, Consider These Steps


Powell River Hospice referral and grief materials

28. Hospice – Palliative Bereavement Client Referral Form
29. Hospice – Volunteer Visitor Program Brochure
30.a. Hospice – Grief – After Suicide
30.b. Hospice – Grief – Children & Teens
30.c. Hospice – Grief – Coping with Challenges
30.d. Hospice – Grief – Special Days & Holidays
30.e. Hospice – Grief – Ten Things to Know
30.f. Hospice – Grief – Things to Remember when Supporting a Grieving Partner Booklet
30.g. Hospice – Grief – Understanding Your Emotions
30.h. Hospice – Grief – What Makes It Difficult


Public brochures developed by the qathet Division of Family Practice

31. All Care Support Brochure – Public brochure about palliative care
32. Planning for Care – Public brochure about Goals of Care and Advanced Care Planning
33. qathet Division YouTube page for Palliative Care – A collection of patient information videos and Palliative Care training videos for nursing staff.