Assessment and treatment of physical symptoms

The 2018 National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines includes recommendations for palliative care assessment and planning.

Guideline 1.2: Comprehensive palliative care assessment. A comprehensive interdisciplinary evaluation of the patient and family forms the basis for the development of an individualized patient and family palliative care plan.

Guideline 1.3: Palliative care plan. In collaboration with the patient and family, the interdisciplinary team (IDT) develops, implements, and updates the care plan to anticipate, prevent, and treat physical, psychological, social, and spiritual needs (Ferrell et al., 2018).

With the growth of palliative care came an increased number of assessment tools available for nurses and the IDT team to determine the type and degree of severity of symptoms befalling patients. There are currently many professional articles and websites that address the care of the patient receiving palliative care. What is presented here is a general overview of care parameters. The reference list contains articles and websites for more detailed information.

Common serious illness in patients needing palliative care include the following:

Typical physical symptoms occurring to palliative care patients are as follows:

Pain, dyspnea, and fatigue have been the most common of all these symptoms reported by approximately 50% of patients (Solano et al. 2006). According to Albert (2017), here are some general principles for treating patients receiving palliative care and end-of-life care.

Overall assessment approach

One of the essential roles for nurses and the IDT in palliative care is assessing the patient's symptoms and discomfort levels. Here is a general assessment approach, from minimum to severe, derived from the Edmonton Symptom Assessment Scale (ESAS) that includes the above common symptoms experienced by palliative care patients (Rauenzahn et al., 2017).




















General clinical recommendation

Evidence rating

Opiates are useful to treat dyspnea in palliative/end-of-life care.


Haloperidol and risperidone (Risperdal) are effective in treating delirium in palliative/end-of-life care.


Hyoscyamine (Levsin) or atropine ophthalmic drops can be used to treat excessive oropharyngeal secretions (Albert, 2017). 


Instant Feedback:

Pain, dyspnea, and fatigue have been the most common symptoms reported by palliative care patients.



Albert, R. H. (2017). End-of-life care: Managing common symptoms. American Family Physician. 95(6), 356-361.

Dalal, S., & Bruera, E. (2017). End-of-Life Care Matters: Palliative Cancer Care Results in Better Care and Lower Costs. The oncologist, 22(4), 361–368.

Ferrell, B.R., Twaddle, M.L., Melnick, A. & and Meier, D. E. (2018). National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. Journal of Palliative Medicine. 21(12), 1684-1689.

Rauenzahn, S.L., Schmidt, S., Aduba, I.O., Jones, J.T., Ali, N, & Tenner, L.L. (2017). Integrating Palliative Care Services in Ambulatory Oncology: An Application of the Edmonton Symptom Assessment System. J Oncol Pract. 13(4), e401-e407.

Solano, J.P., Gomes, B., Higginson, I.J. (2006). A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease, and renal disease. J PainSymptom Manage.31(1), 58-69.

Strasser, F., Sweeney, C., Willey, J., Benisch-Tolley, S., Palmer, J. L. & Bruera, E. (2004). Impact of a half-day multidisciplinary symptom control and palliative care outpatient clinic in a comprehensive cancer center on recommendations, symptom intensity, and patient satisfaction: A retrospective descriptive study, Journal of Pain and Symptom Management, 27(6), 481-491.