symptom evaluation in palliative medicine: patient report vs. systematic assessment.

Symptom evaluation in palliative medicine: patient report vs systematic assessment The median number of symptoms found using systematic assessment was tenfold higher (p<0.001) than those volunteered. Specific detailed symptom inquiry is essential for optimal palliation in advanced disease.

Full Answer

What is a symptom Assessment Scale in palliative care?

The PCOC Symptom Assessment Scale (SAS) is a patient-rated tool to measure the amount of distress caused by seven of the most common symptoms in palliative care. Staff need to know how bothered, worried or distressed patients are by each of the symptoms in order to effectively manage what matters to patients.

What is symptom evaluation?

Symptom assessment usually involves taking a detailed history from the patient to understand the cause and severity of the symptom.

What is the symptom Assessment Scale?

The Symptom Assessment Scale (SAS) uses a 0-10 numerical scale with zero being no symptom and 10 being the worst possible. The key symptoms included in the scale are breathing, bowel problems, appetite problems, pain, insomnia, nausea and fatigue.

What is symptom management in palliative care?

Listen to pronunciation. (SIMP-tum MA-nij-ment) Care given to help relieve the symptoms of a disease, such as cancer, and the side effects caused by treatment of the disease.

What is a symptom analysis tool?

The Symptom Assessment Tool has been developed to assist with identifying and monitoring residents who's health needs are deteriorating. It is a traffic light system that should help to quickly rate the symptoms and provide practical guidance on the next steps.

What is symptom identification?

Symptom assessments often employ checklist self report ratings. Many symptom surveys, such as the Memorial Symptom Assessment Scale, were originally designed for use in outpatient cancer care and require retrospective recall about symptom presence and intensity during the preceding days or weeks.

What is rug in palliative care?

The Resource Utilisation Groups—Activities of Daily Living (RUG-ADL) scale measures the motor function of a patient for four activities of daily living.

What is the Edmonton scale?

A questionnaire used to rate the intensity of nine common symptoms experienced by cancer patients, including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath.

What is the palliative care problem severity score?

Background: The Palliative Care Problem Severity Score is a clinician-rated tool to assess problem severity in four palliative care domains (pain, other symptoms, psychological/spiritual, family/carer problems) using a 4-point categorical scale (absent, mild, moderate, severe).

What is the most common symptom experienced in palliative care?

Pain and difficulty in breathing are two of the most frequent and serious symptoms experienced by patients in need of palliative care.

Why is symptom management important in palliative care?

Symptom management is an essential aspect of palliative and end-of-life care, but evidence suggests that patients' symptoms may not always be relieved, causing significant harm to patients and magnifying their relatives' distress.

What is the symptom management model?

Our model has three dimensions: the symptom experience, symptom management strategies, and symptom outcomes (see Figure 1). It is based on the premise that the three dimensions are interrelated because, to effectively manage a symptom, all three dimensions should be considered.

Abstract

This study examined symptoms reported by patients after open-ended questioning vs those systematically assessed using a 48-question survey.

Introduction

An estimated 555,500 Americans died from cancer in 2002 [ 1 ]. Relieving distressing symptoms and managing complications are essential in improving the quality of life of patients with advanced cancer [ 2 ]. Advanced cancer patients are polysymptomatic with a median of 11 (range 1–27) symptoms [ 3 – 5 ].

Materials and methods

We conducted a prospective study to compare the number of symptoms volunteered during interview vs those chosen on a 48-item survey (systematic assessment). The 48-item survey was an empirically derived investigator-developed checklist of symptoms experienced by patients with advanced cancer.

Results

Two hundred and sixty-five consecutive patients were enrolled and screened. Sixty-five were not assessed; of these, >50% were delirious or sedated and 69% had an ECOG of 4. Two hundred were entered in the study (Table 1 ); 107 (54%) were men and 93 (46%) women. Median age was 65 years (range 17–90).

Discussion

An important principle in medical history taking is to ask open-ended questions to “allow patients to tell their own story.” However, in palliative care where the aim is to control the pain and other symptoms as much as possible to provide patients and their families the best quality of life, this may fail to detect aspects of the patients' symptomatology.

Conclusions

There is a major discrepancy between the symptoms that persons with advanced disease experience and what they spontaneously report to their physicians. Symptoms such as early satiety, drowsiness, dry mouth, insomnia, and weight loss were common but often not volunteered.

Author information

The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, The Cleveland Clinic Foundation, 9500 Euclid Avenue, M76, Cleveland, OH, 44195, USA

Author information

1. The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, The Cleveland Clinic Foundation, OH 44195, USA.

Abstract

This study examined symptoms reported by patients after open-ended questioning vs those systematically assessed using a 48-question survey.Consecutive patients referred to the palliative medicine program at the Cleveland Clinic Foundation were screened.

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