From the Guidelines
A comprehensive palliative care assessment should include evaluating benefits and risks of anticancer therapy, physical symptoms, psychosocial or spiritual distress, personal goals and expectations, educational and informational needs, and cultural factors affecting care, as recommended by the most recent guidelines 1. To effectively evaluate and address a patient's needs, I recommend using a structured assessment form that covers:
- Physical symptoms, including pain, dyspnea, nausea, fatigue, anxiety, and depression
- Psychological status, including coping mechanisms and support systems
- Social concerns, including caregiver burden and financial concerns
- Spiritual needs, including sources of meaning, religious practices, and existential distress
- Functional status, using the Palliative Performance Scale (PPS) or Karnofsky Performance Status The assessment should also include medication reconciliation, advance care planning status, and goals of care discussions, as outlined in the guidelines 1. Regular reassessment using this form helps track symptom progression and treatment effectiveness, allowing the palliative care team to adjust interventions accordingly and improve quality of life for patients with serious illness, as supported by the evidence 1. It is essential to prioritize a patient-centered approach to assessment, treatment planning, and care, by assessing the patient's goals and expectations for treatment early in the assessment process, as recommended by the guidelines 1. By following this comprehensive approach, healthcare providers can ensure holistic care and improve outcomes for patients with serious illness, in line with the principles of palliative care 1.
From the FDA Drug Label
When managing patients taking opioid analgesics, particularly those who have been treated for a long duration and/or with high doses for chronic pain, ensure that a multimodal approach to pain management, including mental health support (if needed), is in place prior to initiating an opioid analgesic taper The assessment for Palliative Care involves ensuring a multimodal approach to pain management, including mental health support if needed, is in place prior to initiating an opioid analgesic taper 2.
- Key considerations include:
- Chronic pain management
- Mental health support
- Multimodal approach to pain management
- Opioid analgesic taper plan
From the Research
Assessment of Palliative Care
The assessment of palliative care is a comprehensive process that evaluates the physical, psychosocial, and spiritual aspects of care for seriously ill patients. According to 3, a majority of clinicians reported tailoring their consultations, with time limitations and workload being the primary reasons for this approach. The study also found that physical symptoms were the most commonly assessed domain, while spiritual and cultural factors were assessed the least.
Components of Palliative Care Assessment
The components of palliative care assessment include:
- Physical symptoms 3, 4
- Psychosocial aspects 3, 5
- Spiritual aspects 3, 6, 5
- Cultural factors 3, 5
- Information and practical needs 5
Tools for Palliative Care Assessment
Several tools have been developed to assess palliative care needs, including:
- The Milford Palliative Care Assessment Tool (MPCAT) 6
- The Multidimensional Objective Pain Assessment Tool (MOPAT) 4
- Patient- and caregiver-reported assessment tools 7
Challenges and Gaps in Palliative Care Assessment
Despite the importance of comprehensive assessment in palliative care, there are several challenges and gaps in this area, including: