Primary Care - Clinical Action - Assess Palliative Care Needs
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Assess Palliative Care Needs

Palliative care can be defined as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." (World Health Organisation, 2016)

Patient assessment is a critical step in identifying when patients would benefit from palliative care. A palliative approach and palliative care needs assessment should be considered for any patient when you would not be surprised if they died within the next twelve months.

The life experiences of a person such as age, culture, religion, ethnicity or experience should be considered.

Re-assessment of palliative care needs should occur regularly and at key transition points in the patient’s trajectory, for example:

  • if there has been a significant functional or medical decline,
  • if there is a sudden acute event,
  • if discussions around goals of care are required particularly around futile treatment,
  • following hospitalisation.

Clinical Tools and Resources

Symptom Assessment Scale (169kb docx)
Palliative Care Outcomes Collaboration
The Symptom Assessment Scale is self-reported tool for patients to identify what symptoms are of most concern. This assessment can also be used to identify whether treatments or medications are effective. It rates seven common symptoms—difficulty sleeping, appetite problems, nausea, bowel problems, breathing problems, fatigue and pain. The Symptom Assessment Scale and the brochures explaining the tool are available in English and also translated versions.

PQRST Method for Pain Assessment

An easy mnemonic to identify important diagnostic clues for pain assessment and management.
Provocation/Palliative—What causes the pain? What makes the pain better or worse?
Quality—What does the pain feel like? Try to let the patient describe the pain in their own words. Sharp-often nociceptive, dull-often visceral, stabbing-often muscle spasm or neuropathic, burning-often neuropathic, crushing-often mediastinal/cardiac.
Region/Radiation—Where is the pain? Does the pain go anywhere else? In one place-often nociceptive, radiating-often neuropathic pain will be dermatomal, start in one place then localised to one spot-visceral and then peritoneal/nociceptive.
Severity—How severe is the pain? Try to use a visual analogue or number scale for replicability. Different patients will find different methods easier to use.
Timing/Treatments—When did the pain start? Is it there all of the time, or does it come and go? How long does it last? What treatments have been tried, and how effective were they?

Clinical assessment of pain (156kb pdf)
Pain Australia
This is a guide to the clinical assessment of pain and includes key points of the neurological, psychosocial and musculoskeletal examination.

 

Abbey Pain Scale (38.2kb pdf)
The Australian Pain Society
This is an instrument designed to assist in the assessment of pain in patients who are unable to clearly articulate their needs.
The Abbey Pain Scale does not differentiate between distress and pain, therefore measuring the effectiveness of pain relieving interventions is essential. The pain scale should be used as a movement based assessment, therefore observe the patient while they are being moved, during pressure area care, while showering etc.

 

Pain Numeric Rating Scale (87.9kb pdf)
Geriatricpain.org
A unidimensional single-item scale that provides an estimate of a patient’s pain intensity.

 

Verbal Descriptor Scale (Pain Thermometer) (73.4kb pdf)
Geriatricpain.org
A pain scale using words to describe pain. This may be helpful for patients who may have with numeral rating but can identify their pain intensity using verbal descriptors.

 

Modified Resident's Verbal Brief Pain Inventory (M-RVBPI) (112kb pdf)
The Australian Pain Society
This instrument designed to assist in the assessment of pain for residents that are able to communicate. The Modified Resident’s Verbal Brief Pain Inventory (M-RVBPI) provides comprehensive information about pain intensity, the site of pain and the physical and psychosocial impact of pain.

Dyspnoea or shortness of breath is a common symptom experienced by many patients with life-limiting illness. Although dyspnoea can be measured in several ways, the impact and significance of symptoms for patients is often best described directly by patients through regular assessment. The patient’s symptoms of dyspnoea can exert a strong influence on patient, family and carer experience throughout the trajectory of serious illness. The Symptom Assessment Scale includes a domain around breathing problems. Assessment of dyspnoea should include collecting information about the onset of shortness of breath (gradual or acute), the relationship to activity, and relieving factors (rest, positioning-forward lean, etc.). Additional investigations may be appropriate to guide management these could include oxygen saturations, bloods, medical imaging, electrocardiogram, etc.

Dyspnoea Visual Analogue Scale (VAS)
This unidimensional single-item scale, usually on a scale of 0-10, provides an estimate of a patient’s shortness of breath.

Modified Borg Dyspnoea Scale (181kb pdf)
This instrument is used to measure the self-reported intensity of the sensation of breathlessness. The Modified Borg Dyspnoea Scale rates dyspnoea on a scale of 0-10 to quantify the intensity of dyspnoea during activity.

Modified Borg Dyspnoea Scale
0 Nothing at all
0.5 Very, Very slight (just noticeable)
1 Very slight
2 Slight
3 Moderate
4 Somewhat severe
5 Severe
6  
7 Very, severe
8  
9 Very, very severe (almost maximal)
10 Maximal

Patient Instructions for the Modified Borg Dyspnoea Scale: “This is a scale that asks you to rate the difficulty of your breathing. It starts at number 0 where your breathing is causing you no difficulty at all and progresses through to number 10 where your breathing difficulty is maximal. How much difficulty is your breathing causing you right now?”

Short Confusion assessment method (short CAM) worksheet (141kb pdf)
Hospital Elder Life Program
An assessment instrument that can be used to detect the presence of delirium in individuals.
Mini-Nutritional Assessment Short-Form (MNA®-SF) (68.4kb pdf)
Société des Produits Nestlé S.A.
This screening tool is used to identify older adults over 65 years of age who are malnourished or at risk of malnutrition. The supporting website provides more information on the tool and to download the tool you need to agree to the website terms and conditions.

Clinical practice guidelines for the psychosocial care of adults with cancer (176kb pdf)
National Cancers Control Initiative
This summary has been developed to assist health professionals in providing optimal evidence-based psychosocial care for adults with cancer, and their families. Prepared by the National Breast Cancer Centre and the National Cancer Control Initiative with funding from the Australian Government, Department of Health and Ageing, this summary provides an overview of the key emotional issues to consider when treating patients with cancer. It includes practical recommendations about specific interventions to promote adjustment, and detect and treat emotional disorders.

 

Kessler Psychological Distress Scale (K10) (64kb pdf)
Black Dog Institute
The K10 is a simple measure of psychological distress as a measure of outcomes following treatment for common mental health disorders. The K10 asks 10 self-reported questions with a 5-value scale. The maximum score is 50 indicating severe distress and the minimum score is 10 indicating no distress.

Needs Assessment Tool for Carers (NAT-CC - Caring for you)
University of Queensland
The NAT-CC is a self-reported tool for carers to identify the care needs of someone living with a chronic condition, and the level of concern they cause. This provides prompts for the carer and/or the health professional to discuss these issues.

Page updated 27 September 2018