Pain and Symptom Management

If there is no further treatment focusing on a cure, people often think that that there is "nothing left that can be done." On the contrary, much can be done for someone who is terminally ill. The type of care given just has a different focus, and there are many options. Many end of life concerns come from people fearing either overtreatment (too much aggressive care) or abandonment (getting no care). As difficult as it is to talk about, it is best to acknowledge these fears and work with the health care team to find a balance that is acceptable.

Many times patients, families or caregivers think it is "too soon" to start hospice care and wait until death is very near. Bringing hospice professionals in at the last minute makes it difficult for them to provide the care that is needed. A better approach is to arrange preliminary home meetings or hospice visits early on and obtain counseling from hospice or other health professionals who can provide useful suggestions on arranging care.

In recent years, there has been growing awareness of the need to provide better pain and symptom management, particularly for cancer patients, throughout the course of their disease. Advances in knowledge about cancer pain and the availability of validated pain measurement tools now make it possible to provide adequate pain relief to cancer patients.

There also has been growing recognition worldwide that many aspects of palliative care are applicable earlier in the course of illness. It is not enough to emphasize control of symptoms once they are well-established. If identified and impeccably managed earlier in the trajectory of illness, many of the symptom problems that afflict dying patients could be either eliminated or more readily managed. Early aggressive treatment of pain, before it becomes intractable, is extremely important if adequate control is to be achieved.

All the guidelines on pain management emphasize that institutional approaches must be interdisciplinary to be most effective. Nurses have major responsibility for assessing and managing patients' pain day-to-day in most treatment settings. Making pain the "fifth vital sign" on hospital charts on which temperature, pulse, respiration, and blood pressure are routinely recorded is now becoming more widespread in U.S. hospitals.