The aim of palliative care is to decrease suffering in patients and families through multidimensional symptoms assessment and the management of distressing symptoms.
The multidimensional assessment
helps to recognize the contribution of the different dimensions to the patient’s symptom expression, and thereby assist in the planning of care.
Good symptom assessment precedes effective symptom treatment.
An initial step in the multidimensional assessment of the patient involves a complete medical history that reviews the disease diagnosis (cancer, AIDS, end-stage chronic obstructive pulmonary disease, congestive heart failure, renal disease, etc.), the chronology of disease-related events, previous and current therapies, and all relevant medical, surgical, and psychiatric problems.
A detailed history includes current and prior use of prescription and nonprescription drugs, alternative medical therapies, drug allergies and previous adverse reactions, and thorough physical examination and review of the laboratory and imaging, if available.
Assessment tools allow for the identification of many more symptoms than do simple unstructured evaluations.
Simple assessment tools are the most appropriate for patients with advanced illnesses because they may be weak and experiencing symptoms that make it difficult to complete a time-consuming and complex assessment tool. Assessment tools (used regularly) are not only useful to diagnose and evaluate the intensity of the symptoms, but also to monitor the effectiveness of therapy and screen for side effects of medications.
Efficient assessment tools include the Edmonton Symptom Assessment Scale (ESAS), the Memorial Symptom Assessment Scale (MSAS), the Rotterdam Symptom Checklist (RSCL), the Symptom Distress Scale (SDS), and many others.
Complex assessment tools have been developed for clinical research use; research instruments may differ from those used in clinical practice.
See reference for details.
Adapted from Oxford American Handbook of Hospice and Palliative Medicine and Supportive Care. 2nd edition, Chapter 2. Edited by Yennurajalingam S and Bruera E. Oxford University Press, 2016. p. 8.