Approach to symptom management in palliative care
Patients with a life-limiting illness frequently experience a range of symptoms due to a combination of the illness itself, disease-modifying treatment and comorbidities. Early identification, thorough assessment and comprehensive management of symptoms are central to high-quality palliative care; even small improvements in symptom management can significantly improve a patient’s quality of life.
The principles of symptom management described in this topic are relevant for the management of all symptoms experienced by patients with palliative care needs. Life-limiting illnesses are complex, and patients frequently experience multiple symptoms at any one time. A patients’ experience of these symptoms can also be affected by the physical, emotional, social, cultural, existential and spiritual challenges associated with their life-limiting illness—see Overview of emotional, psychological and behavioural symptoms in palliative care.
A multidisciplinary, multidimensional approach to assessing and treating symptoms in palliative care can address concurrent symptoms simultaneously. For example, if a patient is experiencing both poor sleep and pain, it is likely that the pain exacerbates poor sleep and vice versa; addressing poor sleep and pain at once can provide effective management of symptoms faster than if they were to be addressed separately.
Detailed clinical assessment is essential to determine the likely cause and to develop an individualised patient-centred management plan for each symptom described. Consider the potential benefits and burdens of each intervention and the patient’s prognosis, preferences and goals of care when developing a plan. Involvement of family and carers in symptom assessment and management planning is important. For patients with limited English proficiency, organise a professional interpreter rather than relying on family members to interpret—see Using interpreters in palliative care.
An essential component of symptom management for patients with palliative care needs is to minimise the burden of treatment, including the number of drugs. A single drug may contribute to the management of more than one symptom.
For advice on rationalising drug therapy, see Medication rationalisation in palliative care.