Activity 3: Symptom Assessment
The previous section showed that the clinical course of every illness will vary. People with life-limiting illnesses may experience a range of symptoms and clinical problems depending on the underlying pathology of the disease, co-morbidities and other psychological, social, and environmental factors. Preventing, minimising and treating these symptoms is an important component of palliative care and promoting quality of life.
People with life-limiting illnesses can experience a wide range of physical and psychological symptoms.
Some of the most common physical symptoms include:
- constipation. 
Some of the most common psychological symptoms include:
- emotional distress
- depression. 
A person's symptoms don't always follow a predictable pattern, although some patterns can be seen and described.
Symptoms are subjective i.e. experienced differently by each person.
Symptoms are multidimensional i.e. having multiple contributing factors and effects.
Routine assessment of symptoms using recognised assessment tools is a core component of palliative care. There are a range of brief symptom assessment tools that can be used in routine practice to identify symptoms.
The Symptom Assessment Scale (SAS) is widely used within Australian Palliative Care Services. It is one of the recommended assessment tools of the Australian Palliative Care Outcomes Collaboration. 
If you identify that an individual is experiencing a symptom, a comprehensive and multidimensional assessment is required to identify appropriate interventions. This is because each symptom can have different causes, effects and meanings. Your comprehensive assessment provides information needed to develop an individualised management plan.
A comprehensive symptom assessment typically involves evaluation of:
- contributing factors (different causal mechanisms usually require different management responses)
- characteristics of the symptoms, such as: intensity, location, quality, temporal nature, frequency, and associated pattern of disability
- the meaning of the symptom to the person, including beliefs about the symptom and the effect on the person's physical, psychological, and social well-being
- behavioural responses to the symptom, such as the actions that the person is taking to manage or cope with the symptom.
The characteristics of the symptoms help determine causal mechanisms, and help you understand the effect on the person. For example:
- assessment of pain quality allows for a clinical diagnosis of the type of pain and subsequently an appropriate treatment plan
- assessment of the impact of pain helps you determine an appropriate plan to minimise its effects
- assessment of how a person is managing their pain helps you determine treatment preferences and develop an appropriate plan for involving them in their care.
To undertake a comprehensive evaluation of symptoms, you may need to gather clinical data from a range of sources, including:
- physical examination
- clinical investigations.
There are a range of comprehensive symptom assessment tools available for use in practice where there is a need to investigate causes and effects of a symptom.
1. CareSearch. (2009). Clinical Practice: Physical. Retrieved September 15, 2010, from www.caresearch.com.au/CareSearch/ClinicalPractice/Physical/tabid/132/Default.aspx
2. CareSearch. (2009). Clinical Practice: Psychological, social, spiritual. Retrieved September 15, 2010, from www.caresearch.com.au/CareSearch/ClinicalPractice/Physical/tabid/132/Default.aspx
3. Palliative Care Outcomes Collaboration. (2011). Symptom Assessment Scale. Retrieved August 7, 2012, from www.pcoc.org.au/
Activity 3: Symptom Assessment
- What does it mean to say that symptoms are subjective?
- What does it mean to say that symptoms are multidimensional?
- Describe the clinical history and investigations you would undertake to assess the causes and effects of breathlessness in patients with chronic heart failure?
- How might the etiology and experiences of breathlessness be similar or different for people with advanced lung cancer?