Symptom Management in Palliative Medicine

Palliative care is an interdisciplinary specialty focused on providing comfort, communication, and support for patients, families, and professional caregivers throughout the course of a life-limiting illness. This chapter discusses assessment and treatment of symptoms and disorders that commonly contribute to patient distress during these illnesses: pain, disorders of the respiratory and gastrointestinal systems, skin disorders, hot flashes, fatigue, pruritis, insomnia, and delirium. This chapter reviews care of the imminently dying patient, discusses methods for assessing patients' symptoms, and provides two examples of valid and reliable symptom measurement systems: the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Achieving symptom control requires the physician to assess patient suffering in all dimensions: physical, psychological, social, and spiritual. The extent of the assessment may be modified, however, based on patients’ prognosis as well as their goals and the burden and benefit of the diagnostic intervention. A 10-step protocol for terminal wean is presented. Signs that patients are entering their final days and symptom management in the last hours of a patient's life are discussed. Tables list the modified Edmonton Symptom Assessment Scale; the Memorial Symptom Assessment Scale; the DOLOPLUS-2 scale (behavioral pain assessment in the elderly); relative potencies of commonly used opioids; conversions between the transdermal fentanyl patch and morphine; symptomatic treatment for dyspnea, cough, and hiccups; pharmacologic treatment of nausea and vomiting; a progressive bowel regimen for patients receiving opioid therapy; treatments for constipation; etiology-based treatment for oral problems; risk factors for pressure ulcers; and applicable medications for physical and psychological sources of distress near the end of life. This chapter contains 12 tables, 120 references, 5 MCQs.

Symptom Management in Palliative Medicine

10.2310/fm.1095 ◽

2012 ◽

Author(s):

Kathy J Selvaggi ◽

Janet L Abrahm

Keyword(s):

Symptom Management ◽

Symptom Control ◽

Hot Flashes ◽

Symptom Assessment ◽

Symptomatic Treatment ◽

Assessment Scale ◽

Transdermal Fentanyl ◽

Memorial Symptom Assessment Scale ◽

Palliative care is an interdisciplinary specialty focused on providing comfort, communication, and support for patients, families, and professional caregivers throughout the course of a life-limiting illness. This chapter discusses assessment and treatment of symptoms and disorders that commonly contribute to patient distress during these illnesses: pain, disorders of the respiratory and gastrointestinal systems, skin disorders, hot flashes, fatigue, pruritis, insomnia, and delirium. This chapter reviews care of the imminently dying patient, discusses methods for assessing patients' symptoms, and provides two examples of valid and reliable symptom measurement systems: the Edmonton Symptom Assessment Scale and the Memorial Symptom Assessment Scale. Achieving symptom control requires the physician to assess patient suffering in all dimensions: physical, psychological, social, and spiritual. The extent of the assessment may be modified, however, based on patients’ prognosis as well as their goals and the burden and benefit of the diagnostic intervention. A 10-step protocol for terminal wean is presented. Signs that patients are entering their final days and symptom management in the last hours of a patient's life are discussed. Tables list the modified Edmonton Symptom Assessment Scale; the Memorial Symptom Assessment Scale; the DOLOPLUS-2 scale (behavioral pain assessment in the elderly); relative potencies of commonly used opioids; conversions between the transdermal fentanyl patch and morphine; symptomatic treatment for dyspnea, cough, and hiccups; pharmacologic treatment of nausea and vomiting; a progressive bowel regimen for patients receiving opioid therapy; treatments for constipation; etiology-based treatment for oral problems; risk factors for pressure ulcers; and applicable medications for physical and psychological sources of distress near the end of life. This chapter contains 12 tables, 120 references, 5 MCQs.

10 / SUPPORTING PATIENT SYMPTOM MANAGEMENT USING EDMONTON SYMPTOM ASSESSMENT SCALE (ESAS)

10.26226/morressier.5afadd8bf314ac000849b203 ◽

2018 ◽

Author(s):

Sherri Cervantez

Keyword(s):

Symptom Management ◽

Symptom Assessment ◽

Assessment Scale ◽

Patient Symptom ◽

Prospective Study of Use of Edmonton Symptom Assessment Scale Versus Routine Symptom Management During Weekly Radiation Treatment Visits

JCO Oncology Practice ◽

10.1200/jop.19.00465 ◽

2020 ◽

Vol 16 (9) ◽

pp. e1029-e1035

Author(s):

Uma D. Goyal ◽

Kristen Riegert ◽

Rajayogesh Davuluri ◽

Shawn Ong ◽

Sun K. Yi ◽

...

Keyword(s):

Symptom Severity ◽

Symptom Management ◽

Assessment Tool ◽

Radiation Treatment ◽

Symptom Assessment ◽

Assessment Scale ◽

Improvement Project ◽

Patient Reported ◽

PURPOSE: During radiotherapy (RT), patient symptoms are evaluated and managed weekly during physician on-treatment visits (OTVs). The Edmonton Symptom Assessment Scale (ESAS) is a 9-symptom validated self-assessment tool for reporting common symptoms in patients with cancer. We hypothesized that implementation and physician review of ESAS during weekly OTVs may result in betterment of symptom severity during RT for certain modifiable domains. METHODS: As an institutional quality improvement project, patients were partitioned into 2 groups: (1) 85 patients completing weekly ESAS (preintervention) but blinded to their providers who gave routine symptom management and (2) 170 completing weekly ESAS (postintervention group) reviewed by providers during weekly OTVs with possible intervention. To determine the independent association with symptom severity of the intervention, multivariate logistic regression was performed. At study conclusion, provider assessments of ESAS utility were also collected. RESULTS: Compared with the preintervention group, stable or improved symptom severity was seen in the postintervention group for pain (70.7% v 85.6%; P = .005) and anxiety (79.3% v 92.9%; P = .002). The postintervention group had decreased association (on multivariate analysis) with worsening severity of pain (OR, 0.13; P < .001), nausea (OR, 0.25; P = .023), loss of appetite (OR, 0.30; P = .024), and anxiety (OR, 0.19; P = .005). Most physicians (87.5%) and nurses (75%) found ESAS review useful in symptom management. CONCLUSION: Incorporation of ESAS for OTVs was associated with stable or improved symptom severity where therapeutic intervention is more readily available, such as counseling, pain medication, anti-emetics, appetite stimulants, and anti-anxiolytics. The incorporation of validated patient-reported symptom-scoring tools may improve provider management.

Wie geht es ihnen heute? – ESAS (Edmonton symptom assessment scale): Audit seines Einsatzes auf einer universitären Palliativstation – Ergebnisse bei 50 Patienten

Zeitschrift für Palliativmedizin ◽

10.1055/s-2006-954176 ◽

2006 ◽

Vol 7 (03) ◽

Author(s):

S von Hofacker ◽

D Faksvåg Haugen

Keyword(s):

Symptom Assessment ◽

Assessment Scale ◽

Equivalência semântica da versão em português do instrumento Memorial Symptom Assessment Scale (MSAS) para avaliar sintomas em pacientes oncológicos

Revista Brasileira de Pesquisa em Saúde/Brazilian Journal of Health Research ◽

10.21722/rbps.v19i2.20584 ◽

1969 ◽

Vol 19 (2) ◽

pp. 83-91 ◽

Cited By ~ 2

Author(s):

Larissa Fernandes Da Rocha ◽

Monique da Silva Carvalho ◽

Ana Amélia Moraes de Lacerda ◽

Áila Ferreira Vizeu Viana ◽

Raquel de Souza Ramos ◽

...

Keyword(s):

Cancer Patients ◽

Symptom Assessment ◽

Assessment Scale ◽

Semantic Equivalence ◽

Portuguese Version ◽

Memorial Symptom Assessment Scale ◽

Semantic equivalence of the Portuguese version ofthe Memorial Symptom Assessment Scale (MSAS) to evaluate symptoms in cancer patients

Exploring the Challenges of Implementing the Edmonton Symptom Assessment Scale in a Specialist Palliative Care Unit

Journal of Palliative Care & Medicine ◽

10.4172/2165-7386.1000128 ◽

2012 ◽

Vol 02 (06) ◽

Cited By ~ 2

Author(s):

M Lucey

Keyword(s):

Palliative Care ◽

Symptom Assessment ◽

Palliative Care Unit ◽

Assessment Scale ◽

Specialist Palliative Care ◽

Development and Validation of a Modified Version of the Edmonton Symptom Assessment Scale in a Flemish Palliative Care Population

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909111400724 ◽

2011 ◽

Vol 28 (7) ◽

pp. 475-482 ◽

Cited By ~ 12

Author(s):

Patricia Claessens ◽

Johan Menten ◽

Paul Schotsmans ◽

Bert Broeckaert

Keyword(s):

Palliative Care ◽

Symptom Assessment ◽

Assessment Scale ◽

Face Validity ◽

Patients With Cancer ◽

The Face ◽

Palliative Care Units ◽

Symptom Assessment Scale ◽

Development And Validation

Palliative cancer patients are faced with multiple symptoms that threaten their quality of life. To manage these symptoms, a reliable and valid way of registration is crucial. In this study, the Edmonton Symptom Assessment Scale (ESAS) has been translated, modified, and tested on content, face, criterion, construct validity, and internal consistency for patients admitted to Flemish palliative care units. These aspects are tested in a descriptive, comparative, longitudinal study based on 3 convenience samples. The first consisted of 8 palliative care experts. The second sample checked the face validity and consisted of 4 patients, 5 family members, and 5 nurses. The last sample involved 23 patients admitted to 3 Flemish palliative care units. Heedful of the “new-wave” vision on validity, the translated and altered ESAS seemed a suitable instrument for the symptom assessment of patients with cancer admitted to a palliative care unit.