Unrelieved pain is the greatest fear among patients with a life-limiting disease. Physicians should consider the legal ramifications of inadequate pain management and understand the liability risks associated with both inadequate treatment and treatment in excess. As the fifth vital sign, pain should be assessed as frequently as the other vital signs and the findings should be well documented, for easy reference by all members of the healthcare team. This review discusses the etiology of pain at the end of life and issues in effective pain management; assessment of pain accurately through use of clinical tools and other strategies, including the use of an interpreter; and select appropriate pharmacologic and/or non-pharmacologic therapies to manage pain in patients during the end-of-life period.

Symptom management is an essential element in any care setting, requiring diligent ongoing assessment and evaluation of interactions. Side effects related to treatment of symptoms must be understood and treated. The goals of symptom management for patients near the end of life are to control symptoms, promote meaningful interactions between patients and families, and facilitate peaceful deaths. Optimum treatment of symptoms involves comprehensive assessment and use of drug and non-drug interventions. It is essential that healthcare providers in all settings become prepared to provide quality care at the end of life. The physical comfort measures must continue, including frequent repositioning and oral hygiene. Emotional support of the family is imperative. This document discusses the symptoms: Fatigue and Weakness; Dyspnea; Constipation; Nausea and Vomiting.

The purpose of this document is the best management of symptoms in end-of-life situations. Before initiating a symptom management approach, pharmacologic or non-pharmacologic, clinicians should allow patients time to express their thoughts and concerns. This simple step has led to better outcomes and when carried out in a supportive environment, has been almost as effective as more advanced techniques. Continual reassessment of symptoms is necessary to ensure adequate management of symptoms. It may be helpful for patients or a family member to keep a pain or symptom diary to note which measures have or have not provided relief and the duration of relief. This information will help clinicians deter­mine the efficacy of specific therapeutic options and modify the treatment plan as necessary. The discussion of interventions in this document focuses on the care of adults. This document discusses the symptoms: Anorexia and Cachexia, Diarrhea; Sleep Disturbances; and Delirium.

This course is designed to bridge the gap in knowledge of palliative care by providing an overview of the concept of palliative care and a discussion of the benefits and barriers to optimum palliative care at the end of life. Before initiating a symptom management approach, pharmacologic or non-pharmacologic, clinicians should allow patients time to express their thoughts and concerns. This simple step has led to better outcomes and when carried out in a supportive environment, has been almost as effective as more advanced techniques. Continual reassessment of symptoms is necessary to ensure adequate management of symptoms. It may be helpful for patients or a family member to keep a pain or symptom diary to note which measures have or have not provided relief and the duration of relief. This information will help clinicians deter­mine the efficacy of specific therapeutic options and modify the treatment plan as necessary. The discussion of interventions in this document focuses on the care of adults. The issue of physician-assisted-suicide or euthanasia is likely to remain high on the medico-legal or ethical agendas of many countries in coming years. One reason, according to some experts, is a growing insistence among patients in many countries on having the final say – in all senses of the word “final” – about their medical treatment. Another reason is that people are living longer and because of medical advances increasing numbers are surviving with debilitating conditions, such as cancer and heart disease. The evidence of more than a dozen years’ experience in Oregon and two years’ data from Washington state suggests that legalized physician-assisted death provides an appropriate and ethically acceptable choice to patients who wish it and who qualify under the statutory guidelines. Along with science, empathy – the humanistic dimension – remains critical. This document discusses the symptoms: Psychosocial Care; Anxiety; Depression, Spiritual Needs; Imminent Death and Physician-Assisted Suicide.