End-of-Life Care: Palliative Management of Symptoms at the End of Life.

As the health status of patients living with multiple chronic conditions declines, these patients experience a variety of symptoms (eg, respiratory, gastrointestinal, psychological symptoms; overall symptoms of decline; and pain). Respiratory symptoms can include dyspnea, cough, and excessive upper respiratory tract secretions. Gastrointestinal symptoms can include nausea and vomiting, constipation, and malignant bowel obstruction. Overall symptoms include anorexia, cachexia, and fatigue. Psychological symptoms may manifest as depression, anxiety, or delirium. For patients with chronic pain and progressive disease, it is important to identify the etiology and type of pain (ie, visceral, somatic, neuropathic) because management differs. An evaluation of total pain should consider the various domains of suffering, including physical, psychological, and spiritual suffering. It is imperative to attempt to identify the underlying causes of the symptoms and address it if possible. It also is important to relieve symptoms using nonpharmacologic and pharmacologic approaches. In patients unable to self-report symptoms, family members and/or caregivers can provide insight into the condition of the patient.