Symptom Assessment in Palliative Care

Transcription

1 Symptom Assessment in Palliative Care Maria Nabal Sumary SYMPTOM ASSESSMENT Is it really necessary? What for? Which symptoms? How to conduct the assessment? Is there any other area of assessment in PC? Main problems The future 2 1

2 Symptom assessment in PC: Is it really necessary? Palliative Care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. National Cancer Control Programmes: Policies and Managerial Guidelines, 2nd Ed. Geneva: WHO, Symptom assessment in PC: what for? This is the first step to successful symptom management It helps to establish the impact of illness in each patient It is one way to evaluate the efficacy of treatment and quality of care It improves the communication by sharing information among patient, family and staff 4 2

3 Symptom assessment in PC: which symptoms? Problem There is no consensus Some solutions Do not forget most prevalent symptoms Use the cluster associations Use a check list and validated tools PC patients report an average of 11 symptoms 5 Symptom assessment in PC: which symptoms? 6 3

4 Symptom assessment in PC: which symptoms? Edmonton Symptom Assessment System 7 Symptom assessment in PC: which symptoms? 8 4

5 How to conduct the assessment? Preliminary considerations: Symptom assessment is more than write a number PC patients are polysymptomatic and easy fatigued There are many barriers: cognitive impairment, etc. Validated scales can supplement clinical interviews but not replace them Self vs observer assessment Assessment chronology: initial - follow up final Dimensions of assessment Psychosocial factors affecting the assessment Which is the best assessment tool? 9 Dimensions of assessment Intensity and impact Localization Chronology Modulating factors Etiology Type / Main characteristics Relation with daily life activities Emotions and thoughts about the symptom 10 5

6 Symptom assessment in PC: which tool? Scales focused on one symptom BPI Fatigue Inventory Constipation Assessment Scale and Bristol Scale Dyspnea scales: (Pall Med 2007;21:177-91) Walking test Borg Sclae The chronic respiratory questionnaire Cancer dyspnoea scale NYA Clasification Scales focused in multiple symptoms ESAS MSAS STAS CAMPAS One-dimensional scales NRS VRS VAS Multidimensional scales: BPI Mc Gill MPAC 11 How to conduct the assessment? Kirkova J et al.american Journal of Hospice & Palliative Medicine 2010; 27(1):

7 Symptom assessment in PC: Main problems Lack of consensus Different content Different aims None of the identified systems is widely applied Holen J et al. JPSM pain measurement tools Hjermstad M et al. (EPCRC) new tools 13 Symptom assessment in PC: Main problems From Ferraz Gonçalves Delphi process 14 7

8 Symptom assessment in PC: other areas of assessment? Multidimensional assessment physic emotional social Biography espiritual 15 Symptom assessment in PC: The future Do we need a standardized approach for cancer pain classification and assessment? Do we need a similar system across settings: Clinic, teaching, research and policy? International meeting on pain classification and assessment (Milan, 9-10 Sept 2009) by EAPC RN,EPCRC and Mario Negri Institute Delphi Process to develop a screening tool (short, not time consuming, but able to detect the main problems) in the first encounter by Dr. Ferraz Gonçalves 16 8

9 For your information

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