Symptom management in palliative care

Palliative care is a specialized area of healthcare that has emerged to respond to the experiences and needs of people with life-limiting illness. Palliative care has been defined by the World Health Organization (WHO) as: ... an approach that improves thwe quality of life of patients and families facing problems associated with life-threatening illness, through the prevention of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual. (World Health Organization(WHO) definition of palliative care, 2004) Consistent with thsi definition, a number of key principles can be identified to underpin a person-centred approach to clinical management in palliative care. These principles include: * the palliative approach is identified as being relevant early in the course of an illness, not just as end-of-life care * palliative care promites holistic care to ensure physical, psychological social and spiritual well-being * the family and significant others are included in the care process * there is an emphasis on impeccable assessment, early identification of problems and implementation of appropriate treatments * disease-modifying treatments, such as chemotherapy and radiotherapy may have a role * palliative care can be provided in any setting * there is an emphasis on a team approach to care. In this chapter, Yates and Hardy introduce Adrian, a man dying of disseminated melanoma and show how these principles can be applied to managing some of the more common clinical problems that arise in palliative care. The chapter focuses on managing common symptoms including pain, dyspnoea, nausea, fatigue and anorexia. Management issues associated with other important and related care needs, such as psychological distress and spiritual concerns are addressed elsewhere in this book. For clarity, each of the symptoms addressed in this chapter is described separately. As seen in Adrian's case, however, patients are more likely to present with several concurrent symptoms. The complex interrelationships between these various symptoms should be considered when identifying an appropriate management plan.