The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 3: Assessment of Physical SymptomsDefinitions of the Words Used to Define Each SymptomIf distress is to be assessed and treated effectively, health care professionals must understandthe words26 picasthat patients use to describe symptoms and, optimally, must use a common language fordescribing symptoms to others in the health care team. In a particular clinical setting, patientsand the health care team usually speak the same “native tongue.” Nonetheless, even in such asetting, clear language is not always used when communicating the detail of symptoms.The problems with this failure of language in the field of symptom assessment are twofold. One,words that people use to describe symptoms may mean different things to different patients.Two, the words used to describe a symptom may have various medical implications.Words May Have Many MeaningsSome of the words used to describe each symptom have a plethora of meanings for patients. Thisproblem of itself can only be approached by careful historytaking and questioning by the clinicianto elucidate the nuances of the language the patient uses to communicate distress. Patientsshould not be described as poor historians. Clinicians must endeavor to be good historians,or good historytakers.The words patients use to describe their symptoms can often have more than one meaning,which highlights the crucial need for detailed and thorough historytaking. For example:• Fatigue may mean to some sleepiness, to others exhaustion, to others muscleweakness, and to still others the word may have other implications.• Shivering implies to most a tremulous shaking that occurs with fever orsepsis. However, patients have also used this word when attempting todescribe the dysesthetic sensation that may occur with neuropathic pain.• Confusion may be used to imply disorganized thinking, forgetfulness,hallucinations, concentration deficits and numerous other changes in mentalstatus.Words Have Various Medical ImplicationsWithin the medical arena, the words used to describe a given symptom may have a wide range ofimplications. Definitions and taxonomies for many symptoms are lacking. Clinicians are ofteninexact in describing the experiences of patients to other clinicians. This problem has clinicalimplications that relate to continuity of care and team communication. In addition, it has researchimplications related to the processes of developing, undertaking and interpreting symptom-relatedresearch studies.Key words that clinicians may encounter in assessing symptoms of patients with HIV are pain,fatigue, breathlessness, and confusion. Consistency is lacking in the application of these andmany other words that are used to describe symptoms. Clinicians need to be more aware of thissemantic problem and to develop consistent tools for medical communication. The variability ofthe meanings of words also highlights the need for clinicians to use validated instruments forsymptom assessment and research. In summary, these observations point to the need for healthprofessionals to explore the meaning of the symptom in detail during the process of symptomassessment.42U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau