Patient Assessment
1) Identifying palliative care needs
-patient with life-limiting illness (metastatic cancer, end-stage organ failure with decreasing benefit from treatment, degenerative neurological condition..)
2) Palliative approach-holistic assessment
-nursing assessment includes –therapeutic relationship, communication skill,collection information and physical examination
3) Advanced care planning conversation
-discuss concern, values, wishes, goals of care, place of care, decision maker, unfinished business
-ongoing conversation- important documentated and reviewed
4) Assessing Prognosis – affect decision on treatment
5) Assessment tools
Examples: ESAS (Edmonton Symptom Assessment System)
SAS (Symptom Assessment Scale), pain diary
ECOG performance status (Eastern Cooperative Oncology Group)
An Australian-modified Karnofsky Performance Scale (AKPS)
6) Case study
-demonstrating comprehensive assessment
-learning points, take-home message
Physical -Assess problem could be reversible or irreversible causes
-Discuss and review goals of care of current problem, investigation, and treatment
-nursing role – assess nursing care oral problem (halitosis, xerostomia (dry mouth), stomatitis, candidiasis, ulcers) skin problem (malignant wound, pressure sore, about the wound-? exudate,malodour,bleeding,infected,about the patient- ? is it painful? How does it affect daily living? How patient cope? If pressure sore, assessing Pressure Ulcer Staging, Stage 1,2,3,4. Assessing oedema ?hypoalbuminemia,? related to CCF or renal failure
Psychological -assessing depression –‘have you been depressed most of the time for the past 2 weeks?’ or ‘Are you depressed?’ , assess others worried, fear, concern, sense of being burden.
Psychosocial -assessing family and caregivers, family distress, financial burden…
Spiritual -spiritual distress –suffering, anger ‘why me?’, guilt, exploration meaning in life
-concept of life and death from different religion
References
Potter PJ, Frish N 2007. Holistic assessment and care: presence in the process.Nurs Clin North Am.42(2):213-28
Hui D et al 2017.The Edmonton Symptom Assessment System 25 years later: past, present and future Developments.J Pain Symptom Management.Mar;53(3):630-643.
www.caresearch.com.au –Patient Assessment
Richard B.L.lim, Diana Katiman. April 2015. Handbook Palliative Medicine in Malaysia.
Hanks G, Cherny N.I, Christakis N.A, Fallon M, Kassa S, Portenoy R.K (2010). Oxford textbook of palliative medicine,4th ed.Oxford University Press: Oxford : UK