Assessing Symptoms

Key points

  • Assess and manage holistically
    • Consider which problems most affect the person’s quality of life (physical, emotional, social, spiritual). Many symptoms are multifactorial, or occur in clusters, and some causes may be more or less reversible than others.
  • Manage pre-emptively
    • Given the nature of this person’s disease, consider what problems may need to be planned for, and ensure that essential medications can be accessed when they are needed.
  • Assess and reassess frequently
    • Consider using simple assessment tools such as the Symptom Assessment Scale (SAS), Distress Thermometer, or a pain diary to screen for and monitor symptoms. Check for adverse effects of treatments, as well as benefits, regularly.
  • Assess whether problems are likely to be due to reversible or irreversible causes
    • Consider and discuss the likely burden associated with various treatment options (cost, difficulty of undergoing investigations, realistic improvement that might be expected etc).
  • Consider both pharmacological and non-pharmacological management options
    • If prescribing, ensure that medications are easily accessible and actually available in community pharmacies and are on the Pharmaceutical Benefits Scheme (PBS). Using the Palliative Care Schedule of the PBS and/or providing authority scripts allows core palliative care medications to be prescribed in larger quantities, and may cost the patient less.
  • Timely referral
    • If a problem does not respond to primary care management, or is complex, refer to specialist palliative care for further advice.

SAS - Assesses core physical symptoms 

Representative image of the PCOC Symptom Assessment Scale

The SAS can be used as:
  • As a pen and paper tool for patients to use, so they can monitor and report their own symptoms
  • As a clinician checklist and aide memoire when reviewing a patient 
  • As a verbal screening / monitoring tool - ask the patient to rate how they have felt over the previous 24 hours, prompting them that a score of 0 means no problem with that symptom and a score of 10 means the worst possible problem
  • Serial SAS scores are a valuable way to monitor disease and treatment.
Download Symptom Assessment Scale form (136kb pdf)
 

From: Palliative Care Outcomes Collaboration (PCOC)


Last updated 14 February 2017