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Approach to symptom assessment in palliative care

Victor T Chang, MD
Section Editor
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD


Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering, and on supporting the best possible quality of life for patients who are facing a serious and/or life-threatening illness and their families [1]. Although some palliative care skills require subspecialty training to learn and apply (eg, negotiating a difficult family meeting, managing refractory symptoms), some core elements of palliative care, such as aligning treatment with a patient’s goals and basic symptom management, should be routine aspects of the care delivered by any practitioner [2]. Palliative care aims to relieve suffering in all stages of disease, and is not limited to end of life care. Within an integrated model of medical care, palliative care is provided at the same time as curative or life-prolonging treatments (algorithm 1). (See "Benefits, services, and models of subspecialty palliative care".)

Patients in the advanced stage of a serious and/or life threatening illness typically experience multiple symptoms, the most common of which are pain, depression, anxiety, confusion, fatigue, breathlessness, insomnia, nausea, constipation, diarrhea, and anorexia (table 1) [3-6]. Patients who have many symptoms are said to have a high symptom burden. These symptoms may result from a number of factors. Among patients with advanced cancer, for example, symptoms may result from the disease (eg, bone pain from metastases, dyspnea from pleural effusions), from treatment (eg, esophagitis with thoracic radiation therapy), or from other concurrent conditions (eg, osteoarthritis).

This topic review provides a suggested approach to assessment for the most common physical and psychological symptoms that arise in patients receiving palliative care for an advanced serious and/or life-threatening illness. The principles underlying the comprehensive palliative care assessment (which include domains other than physical and psychologic symptoms), and an overview of treatment for symptoms commonly encountered in a palliative care population are provided elsewhere. (See "Overview of comprehensive patient assessment in palliative care" and "Overview of managing common non-pain symptoms in palliative care".)


Patient descriptions of physical symptoms and their severity are the primary data for symptom assessment in palliative care. Exploring patients’ reports of symptoms requires thoroughness, persistence, and patience; this is a fundamental aspect of patient-centered care.

It is important to assess mental status and stamina before starting to elicit information as to the nature and severity of symptoms. Seriously fatigued patients may only be able to answer a few questions briefly, and more than one visit may be necessary. Patients who are confused or delirious will not be able to cooperate fully, making symptom identification and assessment difficult; failure to recognize delirium may lead to inaccurate assessments and inappropriate therapies [7]. (See "Diagnosis of delirium and confusional states".)


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