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Symptom Domain Symptoms
Symptom Domain Symptoms
Symptom Domain Symptoms
Chronic illnesses are marked by fluctuations and variations over time. Individuals with chronic illness
experience pain and other symptoms that are not always adequately managed. Their caregivers often have to
deal with enormous burden as the illness progresses. Palliative care can serve as an intervention to manage
chronic illness, not just at the end of life but also in the early phases of illness.
The World Health Organization (WHO) defines palliative care as an intervention that improves the quality of
life of patients and their families experiencing intermittent illness, with the ultimate goal being to offer pain
and symptom relief, as well as spiritual and psychosocial support.
Non-cancer chronic illness
Chronic illnesses are characterized by fluctuations in trajectory, uncertainty in prognoses, extended disease
timelines and stress. The Centers for Disease Control states that chronic diseases—such as heart disease,
stroke, cancer, diabetes and arthritis—are among the most common, costly and preventable of all health
problems. Chronic diseases are also the leading causes of disability and death.
Palliative care can improve the quality of life of patients and their families through timely identification of
deteriorating health, holistic assessment of needs, management of pain and other problems (physical,
psychosocial, and spiritual), and person centered planning of care.
Common Symptoms at the End-of-Life
Variations
Setting
Task‐specific (Advanced Directives vs P&SM)
Disease‐specific (Cancer vs CHF)
Symptom‐specific (Pain)
Delivery method (Face to face, telephonic, video)
Palliative care may include the following
Building rapport and relationships with patients and family caregivers
Managing symptoms, distress, and functional status (eg, pain, dyspnea, fatigue, sleep disturbance,
mood, nausea, constipation).
Exploration of understanding and education about illness and prognosis.
Clarification of treatment goals
Assessment and support of coping needs (eg, provision of dignity therapy)
Assistance with medical decision making
Coordination with other care providers
Provision of referrals to other care providers as indicated
Palliative Care “Triggers”
General considerations clinicians should use to identify patients who would benefit from palliative care
include:
1) Disease progression, especially with functional decline.
2) Pain and/or other symptoms not responding to optimal medical treatment
3) Need for advanced care planning
4. Not surprised if the patient were to die within 12 to 24 months
Conditions that may prompt the initiation of palliative care include, but are not limited to:
Debility/Failure to Thrive
Dementia
Complex care requirements
Cancer
Metastatic/recurrent
Patient desires continued curative treatment(s)
Advanced COPD
Advanced congestive heart failure
Stroke
Decreased function by at least 50%
End stage renal disease
Ventilator dependent
Chronic disease that is now life-limiting
Catastrophic illness/injury
Concomitant disease process
Liver disease
Diabetes
Moderate renal disease
Moderate COPD
Moderate congestive heart failure
Common Symptoms Across Life-limiting Disease Settings:
Overall Fatigue
Pain
Dyspnea
Delirium
Anorexia
Cancer o Pain
Fatigue
Anorexia
Anxiety
Depression
Heart Failure o Dyspnea
Fatigue
Pain
Anxiety
Sleep disturbances
COPD o Dyspnea
Fatigue
Xerotomia
Coughing
Anxiety
Renal Disease o Fatigue
Sleep disturbances
Pain
Anxiety
Constipation
End-stage Liver Disease
Depression
Sleep disturbances
Fatigue
Muscle cramps
Cachexia
HIV/AIDS
Diarrhea
Fatigue
Depression
Pain
Delirium