Core Modules

module 3 | Activity 3: Principles of assessment

Assessment is important in all healthcare; however, impeccable assessment is extremely important to palliative care because of the pervasiveness and complex nature of the symptoms encountered. The person’s care plan, and any changes that may occur to it, are directly informed by comprehensive and holistic assessments.

Palliative Care Australia [1]

Impeccable assessment

A detailed clinical assessment is essential to ascertain the likely cause of each symptom and to develop an individualised patient-centred management plan.[2] Impeccable assessment involves repeatable, evidence-based, systematic physical and psychosocial/spiritual assessment, leading to early identification and the creation of the resultant care plan.[3]

Impeccable palliative care assessment is:[3, 4]

  • Comprehensive
  • Delivered in a timely way
  • Documented
  • Undertaken frequently
  • Reassessed regularly, and as needed
  • Holistic (includes physical, emotional, social, cultural and spiritual)
  • Inclusive of carers and family’s needs (ie, family and carers should routinely be included in assessment to ensure that they are able to secure the information and support they require to meet their needs).

To undertake a comprehensive evaluation of symptoms you will need to gather data from a range of sources, including:[2, 5]

Conversations with the person and their family
Consider:

  • The person’s description of the symptom including severity and factors that exacerbate or relieve it
  • Whether treatments (pharmacological and non-pharmacological therapy, including complementary therapies) have already been attempted
  • The resulting outcomes of any past treatments
  • The impact of the symptoms on the person and whether other factors influence this impact (including psychosocial concerns)
  • The person’s understanding of their illness, prognosis and how the symptom corresponds with these
  • What the person believes is causing the symptom
  • What is concerning the person about the symptom
  • If there are any other practical concerns that might influence the choice of treatment, including cultural, spiritual and geographical factors
  • The person’s current and intended place of care
  • The person’s expectations of treatment, fears and concerns regarding their illness and their future (such as fear of abandonment).
Physical examination and clinical investigations
Consider:

  • The corresponding clinical examination findings, including the person’s baseline and current functional status
  • Any possible clinical investigations that are required to ascertain the cause of the symptom that will influence decision-making about treatment options
  • Whether the possible pathophysiology and cause(s) of the symptoms are due to illness progression, treatment, medication or concurrent illness.
Observation
Consider:

  • How the person responds to treatment
  • Any changes in the person’s quality of life
  • How treatments affect the overall holistic condition of the person.

The clinical assessment can assist with discovering:[2]

Characteristics of symptoms Characteristics of symptoms includes:

  • Intensity
  • Location
  • Quality
  • Temporal nature
  • Frequency
  • Pattern of disability.
Contributing factors Different causal mechanisms can require different management responses.
Behavioural responses Behavioural responses to the symptoms include the actions that the person is taking to manage or cope with the symptoms.
Meaning of the symptom The meaning of the symptom to the person, including beliefs about the symptom and the effect on the person’s physical, psychological and social wellbeing.

Expert opinion

  1. Why is it important to complete a holistic assessment rather than focus on the physical dimensions of care alone?
  2. List and describe the key principles for undertaking a multidimensional assessment of the symptoms for people with a life-limiting illness.
  3. The palliative care physician in the expert opinion video provides key points on assessing symptoms for people with life-limiting illnesses. Compare the points made by the palliative care physician with those you have identified in Question 1.
  4. Review the current guidelines on heart failure. Describe the clinical history, assessment and investigations you would undertake to assess the causes and effects of breathlessness in people with chronic heart failure.
  5. How are the aetiology and experiences of breathlessness similar or different for people with advanced lung cancer compared with chronic heart failure?
  1. Palliative Care Australia. National Palliative Care Standards. 2018; 5th Edition:[Available from: http://palliativecare.org.au/standards].
  2. Therapeutic Guidelines Ltd, Principles of symptom management in palliative care. 2018: Melbourne.
  3. World Health Organization. Definition of Palliative Care. 2017  [cited 2017 March 13]; Available from: http://www.who.int/cancer/palliative/definition/en/.
  4. Palliative Care Australia, National Standards Assessment Program. Quality Report 2010-2015. 2016, Canberra: Palliative Care Australia.
  5. Chang, V., Approach to symptom assessment in palliative care. UpToDate, 2015.