Accurate assessment of the difficulty that a patient has while breathing while in end-of-life care can be challenging. Dyspnea is often under-detected and undertreated, and there is poor agreement between patient perception and professional assessment of dyspnea. Moreover, impaired cognition and communication increase the challenges of assessing dyspnea and respiratory distress in patients.
The use of validated assessment tools for dyspnea and respiratory distress can promote better care.
is a symptom
, the subjective experience of breathing discomfort: it depends on self-report. In contrast, respiratory distress
refers to observable signs (heart rate, respiratory rate, distressed facial expression) that suggest labored breathing—increase in the work of breathing. Unfortunately, discrepancies are common between a patient’s perception of their dyspnea and the caregiver’s.
In patients who can self-report: no optimal scale for patients with serious illness has been identified.Simply asking a patient if they are short of breath (yes/no) is insufficient.
Many scales are easy to use, but it is important that the clinical team is comfortable with the tool and utilizes the same tool in a consistent mode.
In patients who cannot self-report dyspnea: the Respiratory Distress Observation Scale (RDOS) is likely the best available tool for evaluating their respiratory distress. A numeric score is assigned for heart rate, respiratory rate, restlessness, paradoxical breathing, accessory muscle use, grunting at end-expiration, nasal flaring, and facial expression of fear (eyes wide open, facial muscles tense, brow furrowed, mouth open, and/or teeth together).
See reference for more information.
Adapted from Murphy C, Simonis J. Assessment Tools for Dyspnea and Respiratory Distress at the End of Life. Palliative Care Network of Wisconsin. Fast facts and concepts #453. Internet. Accessed on December 8, 2022.