Palliative Care – Symptom Management: By Robin Love M.D.
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Palliative Care – Symptom Management
Whiteboard Animation Transcript
with Robin Love, MD
https://medskl.com/Module/Index/symptom-management
Many patients with advanced life-threatening diseases have difficult symptoms that reduce the quality of their life. It’s important that we do everything we can to treat the symptoms and relieve their distress.
Common symptoms include pain, nausea, dyspnea, fatigue, constipation, delirium and others. It is hard for patients to do the most important things with their remaining time if they have severe pain or are vomiting continuously.
A focused history, physical exam and investigations will help us understand the extent of their symptoms and possibly determine the underlying cause. Any investigations should be thoughtfully planned and only ordered if the result will influence our management.
The tool OPQRST can be helpful as an outline when taking a history of the symptom:
O – Onset: When did it start?
P – Provoking: What makes it better or worse?
Q – Quality: How does the patient describe the pain?
R – Region: Where is the pain?
S – Severity: From 0 to 10, with 0 being no symptom and 10 being the worst they can imagine.
T – Treatments: What have they tried and has it helped?
Most patients have more than one symptom and I find it helpful to create a problem list with a specific plan for each problem.
There are many non-pharmacological approaches that can be helpful for patients. These include physical measures such as positioning, pillows, splints, fans for airflow, heating pads, ice, massage and others. Counseling, relaxation exercises and music therapy may be helpful as well.
Pharmacological approaches are also necessary in most cases. Proper use of common medications like morphine, metoclopramide, haloperidol, lorazepam, senna, and a few others can effectively manage the symptoms in most patients. Primary care physicians should be able to manage the symptoms in the majority of their patients. Additional resources are available to assist with management of more complex patients.
What you need to know is that many patients in the last months of their life have symptoms that can be well managed. The solutions are often quite easy and straightforward. We all have a responsibility to provide this care.
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