People with a life-limiting illness can experience a number of common symptoms and clinical concerns. The nature and severity of symptoms and clinical concerns will vary for each person, because they are:[1-4]
- Subjective: They are experienced differently by each person
- Multidimensional: Symptoms can have multiple contributing factors and effects.
Each person will have a separate set of circumstances and experiences which can influence their response and ability to manage their symptoms. These factors form part of the multidimensional nature of symptoms and influence the person’s subjective response. They include:
- Spiritual factors, including existential distress
- Psychological factors including anxiety and depression
- Cultural experiences and history
- Perceived meaning of the symptom
- Social concerns, including loss of control, loss of income, change of family role and perception of how they are viewed by others
- Past experiences
- Age of the person
- Performance status.
Common symptoms in palliative care include pain, fatigue, swallowing difficulties, anorexia, weight loss and cachexia, nausea and vomiting, constipation, bowel obstruction, dyspnoea, cough, neurological and neuromuscular symptoms, psychological symptoms, sleep concerns and dermatological symptoms.
Further information on common symptoms and their management can be found at:
Consider these common symptoms in relation to Herbert.
Herbert and his wife are self-funded retirees who spend their winter in the north of Australia to escape the cold. On their most recent trip, Herbert noticed he was much more tired than usual. He had trouble catching his breath and needed to sleep on extra pillows in order to breathe when he was laying down.
He was diagnosed with systolic heart failure five years ago.
People with heart failure are usually classified according to the severity of their symptoms. The National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand use the New York Heart Association (NYHA) Functional Classification for classifying different levels of heart failure. This classification system places people in one of four categories based on how much they are limited during physical activity. Herbert was initially classified as Class II heart failure.
Herbert’s illness has been well controlled with medication.
- What were some of the common symptoms that Herbert reported that led to his diagnosis?
- Review the current guidelines on heart failure. Outline the symptom characteristics in each of the four classes of heart failure.
- Describe what is meant by the term “multidimensional”? How are Herbert’s symptoms multidimensional?
- Describe what is meant by the term “subjective”? In what way are Herbert’s symptoms subjective?
- How have Herbert’s symptoms affected his quality of life – and his ability to function?
- Hartogh, G.D., Suffering and dying well: on the proper aim of palliative care. Medicine, Health Care, and Philosophy, 2017. 20(3): p. 413-424.
- Shute, C., The Challenges of Cancer Pain Assessment and Management. The Ulster Medical Journal, 2013. 82(1): p. 40-42.
- Coghill, R.C., Individual Differences in the Subjective Experience of Pain: New Insights into Mechanisms and Models. Headache, 2010. 50(9): p. 1531-1535.
- Palliative Care Expert Group, Principles of symptom management, in Therapeutic Guidelines: palliative care. 2016, Therapeutic Guidelines Limited: Melbourne. p. 135-143.
- Palliative Care Expert Group, Therapeutic Guidelines: palliative care. 4 ed. 2016, Melbourne: Therapeutic Guidelines Limited.
- Atherton, J.J., et al., National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the Prevention, Detection, and Management of Heart Failure in Australia 2018. Heart, Lung and Circulation, 2018. 27(10): p. 1123-1208.