Abstract

July 2006

Section Clinical Essentials

The goal of palliative care is to provide comfort and support for both patient and family through the course of a life-threatening illness. Controlling a patient's physical and psychological symptoms are two of the primary ways in which a physician can achieve this goal. This chapter discusses methods for assessing patients' symptoms and provides two examples of valid and reliable symptom measurement systems: the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. The symptoms that most commonly contribute to patients' suffering in terminal illness are also reviewed: pain; respiratory, gastrointestinal, mouth, and skin problems; and delirium. For patients with respiratory distress, mechanical ventilation is often attempted, but when it fails to improve the patient's condition, terminal ventilation withdrawal may be necessary. A 10-step protocol for terminal wean is presented, and symptom management in the last hours of a patient's life is discussed. A figure shows the treatment for productive cough and nonproductive cough. Tables list the modified Edmonton Symptom Assessment Scale, the Memorial Symptom Assessment Scale, drug treatment for dyspnea, management of nausea and vomiting, medications for nausea and vomiting, a progressive bowel regimen for patients receiving opioid therapy, treatments for constipation, local measures for oral problems, risk factors for pressure ulcers, and drug treatment for agitation or delirium. This chapter contains 83 references.

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