Palliative Care Plan Templates – Samples and Examples

This Palliative Care Plan Template helps clinicians record and manage the changing needs of patients with serious illnesses. It offers a clear format for tracking symptom changes, care goals, family support, and team collaboration. When paired with SOAPsuds, the AI medical scribe for clinicians, the template makes it easier for palliative care providers to:

Capture thorough notes on physical condition, pain levels, diet, medication updates, and emotional health during visits or follow-ups.

Work with family members and hospice staff by documenting caregiver skills, education provided, and equipment requirements such as oxygen or hospital beds.

Plan the next steps in treatment, which may include future visits, medication refills, and communication across the broader care team.

What is a Palliative Care Plan Template?

A palliative care plan template is a structured clinical tool used by providers to outline, document, and oversee care for patients with advanced, long-term, or terminal illnesses. Its main goal is to ensure that medical, emotional, and comfort-related care remains consistent with the patient’s values, choices, and goals.

This format can support both early-stage palliative care, which often starts at diagnosis alongside standard treatment, and later-stage palliative care, or end-of-life care, where the main focus is on patient comfort, dignity, and overall well-being.

In this article, we will highlight the key parts of early palliative care, review the four main components of care plan templates, explain the “7 Cs” framework in a hospital setting, provide tips on creating patient-focused care plans with examples, and share ready-to-use AI-powered templates for clinical practice.

Essential Components of Palliative Care Plan Templates

For best results, palliative care plan templates should guide providers to create complete documentation while allowing flexibility to meet the changing needs of each patient.

Below are the four “core elements” of palliative care plan templates that help maintain clinical accuracy, focus on patient priorities, and improve teamwork across disciplines:

Clinical Assessment and Symptom Tracking

The first section documents the patient’s current health condition. This includes pain level, appetite, hydration, breathing, bowel and bladder function, and mental clarity. Objective data such as vital signs, exam findings, or lab reports should be included to support evidence-based symptom control.

It is important to update this section regularly between visits so the care plan accurately shows any changes in the patient’s condition.

Medication and Symptom Management Plan

This part outlines the patient’s medicines, dosages, recent updates, and how the patient has responded. For symptom management, it should describe strategies used to handle issues like pain, anxiety, constipation, or shortness of breath.

Caregivers should also be given clear notes on possible side effects, how medicines are delivered, and detailed instructions for use.

Family Support and Patient Education

The third section explains the role of family and caregivers in applying the care plan. It should record the caregiver’s abilities, education given to them, and any emotional or spiritual support requested by the patient.

Adding this information strengthens shared decision-making between providers and patients. It ensures that the patient’s preferences, values, and goals remain at the center of their care journey.

End-of-Life Planning and Follow-up Coordination

As a patient’s illness progresses, early palliative care may lead into end-of-life planning. This section includes prognosis conversations, hospice referrals, and documentation of comfort care requests.

It should also cover advance directives, funeral preferences, and Do-Not-Resuscitate (DNR) orders when applicable.

What are the 7 Cs of Palliative Care Plans in Hospitals?

The “7 Cs” model gives hospitals and care teams a simple way to ensure that palliative care plans are complete, compassionate, and aligned with patient wishes. Each “C” represents an essential aspect that supports quality care, from easing symptoms to respecting ethical decisions.

Let’s look at each “C” and how it helps guide care teams in creating and carrying out effective palliative care plans:

Coordination

Palliative care requires teamwork across nurses, doctors, social workers, and chaplains if requested. To keep everyone aligned, care plans must be updated after each visit and stored in a way that makes them accessible across shifts, departments, or care settings.

Comfort

Palliative care plans must prioritize the patient’s comfort. This usually involves pain relief and reducing other symptoms through both medicines and non-drug methods such as music therapy, gentle touch, or repositioning for those who are bedridden. Comfort is always the main goal of palliative care.

Communication

Consistent communication between providers, patients, and families ensures that care remains high-quality throughout the palliative process. It helps teams stay updated on patient needs and preferences so plans can be revised promptly.

Caring

A palliative plan is more than a checklist of tasks. Compassion, empathy, and presence are vital. For example, a nurse sitting with a patient as they share fears of dying and offering reassurance, even when solutions are limited, can ease their emotional burden.

Continuity

Regardless of location—hospital, home, or hospice—palliative care plans should ensure that patient preferences are respected at all times. The template should make clear how care will remain consistent across different settings.

Choice

Respecting patient choice is one of the most critical parts of a palliative care plan. Document their decisions about treatment limits, such as DNR orders, Do-Not-Intubate orders (DNI), and requests for comfort-focused care only.

As long as the patient can express their wishes, advanced directives should be recorded so that their choices are honored when their condition declines.

Finding Closure

Beyond the end of medical treatment, closure in palliative care is about helping patients and families deal with emotions of grief, reflecting on life meaningfully, and allowing space for last conversations, religious practices, or personal goodbyes. Whether through faith or personal rituals, these actions give patients a chance to feel peace while offering families a way to start their own healing process.

Together, the “7 Cs” act as the base for compassionate and effective palliative care. Yet putting these ideas into practice daily, especially when paperwork continues to grow, can be difficult for clinical teams. This was the situation at Hospice & Palliative Care Center, a practice committed to senior care but increasingly burdened by documentation.

At Hospice & Palliative Care Center, many providers found it hard to manage paperwork alongside direct patient care, often sacrificing their own time. “At the end of the day, you’re generally a lot more tired, yet I would stay over an hour late, going through documents, writing referrals… It was difficult to manage,” said Robert Langford, nurse partner and lead advanced care practitioner at Hospice & Palliative Care Center.

Their solution was SOAPsuds AI Medical Scribe. This AI medical scribe not only managed referrals and notes automatically but also improved their consultation process. “It was life changing,” Ian explained. With SOAPsuds, Hospice & Palliative Care Center House Surgery cut administrative work by as much as 60%, improved quality of consultations, and lifted team morale. “The more you use it, the more it benefits your team and patients.”

Building a Patient-Focused Palliative Care Plan with Practical Cases

Patient-focused care means that the plan respects what the patient values, believes, and wants. Since no two people—even with the same diagnosis—go through illness in the same way, it is important that palliative care plans are developed with the patient’s agreement. Below are steps to achieve patient goals along with short case examples for clarity:

Begin with patient priorities, not just diagnosis

Don’t assume every patient wants a long life or aggressive treatment. Ask open-ended questions such as “What matters most to you right now?” Document the patient’s wishes about comfort, care setting, communication, and spiritual or cultural needs, then make sure these are followed throughout the course of care

Sample Case:

Instead of focusing mainly on pain medication, a patient with Chronic Obstructive Pulmonary Disease (COPD) says their main wish is “to breathe well enough to attend my granddaughter’s wedding.” You then update the plan to include oxygen support and mobility help to make that possible.

Respect culture, beliefs, and values

Ask patients about their faith, traditional rituals, or dietary needs and include these in the plan. Use culturally sensitive communication, and where needed, involve an interpreter to bridge language gaps. Make sure these non-medical requests are recorded and respected.

Sample Case:

A devout Muslim patient asks for same-gender caregivers and daily prayer time. The care plan reflects these requests and also includes support from an imam for spiritual needs.

Adjust the plan as illness changes

Set times to check progress since patient goals often shift as conditions worsen. Because chronic and terminal illnesses move forward at different speeds, add notes for when to update the plan outside regular schedules. Be open with patients and families about changes in outlook and care choices as illness advances.

Sample Case

At first, the patient prefers staying home, but as their weakness grows, they ask for inpatient hospice. The plan is quickly revised to make the transition smooth.

Bring in family and caregivers during decisions

If the patient agrees, encourage family members to be present for planning discussions. Identify the main caregiver, note their abilities and concerns, and provide both education and emotional support to help them manage their responsibilities.

Sample Case:

A daughter worried about giving her father morphine shares her concern. The care team arranges a home nurse visit and provides written steps, helping her feel secure instead of stressed.

Example of a Palliative Care Plan Template

Palliative care plans need detailed notes and strong teamwork among clinicians. Handling this manually can be time-consuming and complex. Using an AI medical scribe makes the process faster and more accurate, while keeping records clear and useful.

Streamlined Palliative Care Plans with SOAPsuds

SOAPsuds is an AI scribe that helps providers create palliative care plans instantly. With patient approval, start recording and SOAPsuds captures the entire consultation. Here’s how it works:

·         Transcribe – Open SOAPsuds on your computer or phone, press Start, and let it record the conversation in the background. You can type extra notes into the context field for SOAPsuds to include.

·         Customize – Afterward, choose a palliative care plan template and SOAPsuds fills in the details in the correct fields.

·         Transform – SOAPsuds can also prepare additional documentation such as hospice forms if required.

SOAPsuds now supports over 5000 consultations weekly, following international standards and local rules, ensuring patient data remains secure in Australia, Canada, the United States, the United Kingdom, and other regions. Learn more about our safety and compliance practices.

Free Palliative Care Plan Templates

Free palliative care plan templates provide healthcare professionals with a structured framework to address patient needs comprehensively. They ensure that physical, emotional, and spiritual aspects of care are considered while saving time in documentation. By using these templates, caregivers can maintain consistency and focus more on delivering compassionate support. Here are three templates: 

Initial Palliative Care Plan Template

Made for family physicians, this template helps capture full assessments for patients starting palliative care. It includes patient details, illness history, medication list, allergies, and social background.

Hospice Comfort Care Plan Template

Built for hospice teams, this template supports accurate recording of patient details, care choices, and symptom management strategies. It also covers required legal and compliance documentation.

Palliative Care Assessment Template

Created for nurses and other providers, this template records the patient’s physical, mental, and emotional condition during hospice care. It includes ESAS scores, cognitive checks, depression screening, and psychosocial assessments.