Assessment and re-assessment are critical in palliative care

Nurses often spend a lot of time caring for people with palliative care needs. Detecting changes in their condition can be more difficult when you regularly visit with a person. Systematic assessment helps to monitor for changes so that care measures can be implemented to prevent and relieve suffering as the end of life is approached.

In practice

Related Resources

Standardised approaches to clinical assessments provide a common language that can enhance communication with other health professionals and the people in your care.

Nurses can use certain assessment tools to assess:

  • needs and deterioration
  • symptoms
  • function
  • family and carer needs.

    Some assessment tools cover a broad range of potential needs , for example:

    Other tools are more specific in their focus and support more in-depth assessments, for example, PAINAD (43kb pdf) or The Modified Borg Scale (mBORG) (181kb pdf).

    Clinical assessment tools should be used appropriately and with caution, and not as a substitute for a comprehensive assessment.

    Communication in assessment

    Communication that is open, respectful, culturally safe, and comfortable enables effective conversations. This forms a key part of providing comprehensive care.

    Nurses use communication skills to:

    • actively listen and allow the person to express themselves; this may involve periods of silence
    • understand the impact of any symptoms and what other factors influence these symptoms
    • understand the person’s priorities and their preferences for care and place of care
    • understand what information the person and their support network want to receive
    • explore practical issues that might influence a person’s choices (e.g. cultural, spiritual, and geographical factors)
    • check that they have a clear understanding.

    For more information, see Communication.

    Tools for overall assessment

    The PEPSI COLA aide memoire for holistic patient assessment.

    (This tool was developed in the UK therefore certain resources within it are specific to the UK.)

    • PCOC Symptom Assessment Scale (SAS) assesses the degree of distress relating to seven common symptoms and identifies the person’s priorities relating to specific symptoms. SAS is completed by the person.
    • Edmonton Symptom Assessment Scale (ESAS) (1.15MB pdf) screens and monitor nine symptoms and has been validated in the palliative care setting. ESAS is completed by the person with a life-limiting illness, if necessary, with the assistance of a family member, friend, health care professional.
    • The POS Symptom list (POS-S) comprises 10 symptoms and two open questions
    • OPQRSTU mnemonic: Onset, Palliating and Provoking factors, Quality, Response to previous treatments, Related factors/symptoms, Severity, Temporality and Understanding
    • use a distress assessment tool e.g. The NCCN Distress Thermometer (167kb pdf)

    Barriers to assessment

    Clinical assessment needs to be comprehensive, systematic, and ongoing; however, barriers to this often exist, such as lack of time, training and understanding of assessment.

    It is worth remembering that people may downplay or not report symptoms because

    • of fears that worsening symptoms reflect disease progression and that treatment may stop
    • they see it as an inevitable consequence of the disease, its treatment, or dying
    • they may stop communicating about distress related to that specific complaint if they have been ignored before
    • they do not want to worry their family
    • they have been brought up to not complain, to be stoic.

    This information was drawn from the following resources:

    1. Palliative care Outcome Scale (POS) [Internet]. 2012 [cited 2022 Sep 26].
    2. Hui D, Bruera E. The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments. J Pain Symptom Manage. 2017 Mar;53(3):630-643. doi: 10.1016/j.jpainsymman.2016.10.370. Epub 2016 Dec 29.
    3. CETL. Breaking bad news Feedback Opportunities, A Training Resource for Healthcare Professionals. 2010.
    4. Chang VT. Approach to symptom assessment in palliative care [Internet]. 2022 [updated 2022 Feb 28; cited 2022 Sep 26].
    5. Chovan JD. Principles of patient and family assessment [Internet]. 2019. In: Ferrell BR, Paice JA, editors. Oxford textbook of palliative nursing. 5th ed. Oxford: Oxford University Press; 2019. [cited 22 Sep 26].
    6. LeBlanc TW, Tulsky J. Discussing goals of care [Internet]. 2022 [updated 2022 Jul 11; cited 2022 Sep 26].
    7. McIlfatrick S, Hasson F. Evaluating an holistic assessment tool for palliative care practice. J Clin Nurs. 2014 Apr;23(7-8):1064-75. doi: 10.1111/jocn.12320. Epub 2013 Sep 17.
    8. Okon TR, Chrsitensen A. Overview of comprehensive patient assessment in palliative care [Internet]. 2021 [updated 2021 Nov 29; cited 2022 Sep 26].
    9. Rawlings D, Hendry K, Mylne S, Banfield M, Yates P. Using palliative care assessment tools to influence and enhance clinical practice. Home Healthc Nurse. 2011 Mar;29(3):139-45; quiz 146-7. doi: 10.1097/NHH.0b013e31820ba808.
    10. Stajduhar KI, Dionne-Odom JN. Supporting families and family caregivers in palliative care [Internet]. 2019. In: Ferrell BR, Paice JA, editors. Oxford textbook of palliative nursing. 5th ed. Oxford: Oxford University Press; 2019. [cited 22 Sep 26].
    11. Therapeutic Guidelines Limited. Symptom assessment in palliative care [Internet]. 2016. [cited 2022 Sep 26]
    12. Therapeutic Guidelines Limited. Distress in palliative care [Internet]. 2016. [cited 2022 Sep 26]
    13. VitalTalk. Discussing prognosis [Internet]. 2019 [cited 2022 Sep 26].
    14. VitalTalk. Transitions/Goals of care [Internet]. 2019 [cited 2022 Sep 26].

    Page created 26 September 2022