ABIM Palliative Care study guide
ABIM Palliative Care · Work through your exam, one topic at a time.
Hospice and palliative medicine is the subspecialty that asks a physician to hold two ideas at once: meticulous symptom control, and a clear-eyed understanding of what a seriously ill person actually wants from the time that remains. The ABIM subspecialty certification exam assesses whether a physician can do both across the full range of settings, from an inpatient consult service to a home hospice visit. The ABIM Palliative Care study guide has 8 sections and about 2,385 words.
01Pain Assessment and Management
Pain is multidimensional - nociceptive, neuropathic, visceral, and 'total pain' encompassing psychological, social, and spiritual suffering. Begin by believing the patient's report, then characterize onset, quality, radiation, timing, and impact on function.
300 words, about 2 min02Non-Pain Symptom Management
Opioids are first-line for refractory dyspnea in cancer and advanced COPD; titrate to symptom relief, not to oxygen saturation. Oxygen helps only hypoxemic patients; a handheld fan and cool airflow help normoxemic patients.
302 words, about 2 min03Communication, Goals of Care, and Advance Care Planning
Serious-illness communication is a procedure: prepare, elicit the patient's understanding and information preference, deliver news in small chunks, respond to emotion before giving more information, and summarize a plan. SPIKES and Ask–Tell–Ask provide scaffolds.
305 words, about 2 min04Psychosocial, Spiritual, Cultural, and Ethical Aspects of Care
Physical symptoms are only one domain. Assess psychological distress, spiritual and existential concerns, social supports, and cultural context.
292 words, about 1 min05Palliative Care Across Disease Trajectories
Cancer typically produces steady functional decline with a recognizable terminal phase. Organ failure - heart, lung, liver, kidney - shows gradual decline punctuated by acute exacerbations, making prognosis difficult and sudden death possible.
291 words, about 1 min06End-of-Life Care, the Imminently Dying Patient, and Bereavement
Look for profound weakness, bedbound status, reduced oral intake, decreased urine output, mottled extremities, Cheyne–Stokes respiration, and altered consciousness. These signs are expected and should be explained to families as part of the dying process, not as failures.
317 words, about 2 min07Palliative Care in Special Populations
Apply geriatric pharmacology: start low, go slow, and review for anticholinergic burden and Beers-list drugs. Deprescribe statins, sulfonylureas, and sedative-hypnotics when goals shift.
277 words, about 1 min08Systems-Based Practice, Regulation, Quality, and Interdisciplinary Care
Palliative care is appropriate at any point in serious illness and can accompany disease-directed therapy. Hospice is a benefit for patients with a prognosis of six months or less who elect comfort-focused care; pediatric patients may receive concurrent curative therapy.
301 words, about 2 min