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Overview of comprehensive patient assessment in palliative care

Tomasz R Okon, 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 (QOL) for patients who are facing a serious and/or life-threatening illness, and their families [1].

Palliative care aims to relieve suffering in all stages of disease and does not have to be limited to end of life care. Palliative care may be provided along with curative or life-prolonging treatments (algorithm 1). In keeping with the family oriented approach, palliative care also extends to the family’s bereavement period.

In addition to symptom management, other objectives of comprehensive palliative support include establishing goals of care that are in keeping with the patient’s values and preferences; consistent and sustained communication between the patient and all those involved in his/her care; psychosocial, spiritual, and practical support both to patients and their family caregivers; and coordination across sites of care. (See "Benefits, services, and models of subspecialty palliative care", section on 'Definitions' and "Advance care planning and advance directives".)

Given the scope of palliative care, a unique approach to clinical evaluation is required. Although a comprehensive palliative assessment includes all the standard elements of a medical history and relevant aspects of the physical examination, it also extends beyond the traditional domains.

An overview of comprehensive patient assessment in palliative care is presented here, including the concept of "total pain" and its clinical ramifications, the adequacy of assessment of palliative care needs in this population, and the components of the comprehensive palliative assessment. Assessment methods designed primarily for care of actively dying patients or for research and quality improvement in palliative care are not discussed here; a more detailed review of the integrated care pathways for the actively dying, the approach to symptom assessment in palliative care patients, a general discussion of the benefits of palliative care, practical tips for discussing goals of care, and the philosophy and utilization of hospice care for patients with terminal illness are discussed separately. (See "Palliative care: The last hours and days of life", section on 'Integrated care pathways' and "Approach to symptom assessment in palliative care" and "Benefits, services, and models of subspecialty palliative care" and "Discussing goals of care" and "Hospice: Philosophy of care and appropriate utilization in the United States".)


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