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 Symptoms• Studies of caregivers have found that caregivers are commonly inaccuratewhen reporting on subjective aspects of the patient experience. 21,2226 picasThis includes, for example, symptoms such as pain and depression.A tendency has been demonstrated for caregivers to be more accuratewhen reporting on objective measures, such as the patient’s ability todress independently. Of note, this is not to imply that caregiver reportsshould be neglected as they can provide vital insights into the patientexperience, especially over time.• Objective signs can be usefully monitored to complement subjective data, butthis information cannot substitute for self-report.For example, nausea assessment should involve a subjective rating by thepatient and may be supplemented by assessment of the frequency of emesis.• In some groups of patients, such as cognitively impaired adults or preverbalchildren, it may be impossible to obtain or interpret patient self-reports.These populations need special care and attention. When such patients areencountered, reports from family members and staff may be the only usefulproxies and the information obtained from these sources should be combinedwith a physical assessment of the patient so that the clinician can fully assessthe situation. Although proxy data should be interpreted with caution, theobservations of a caregiver who knows the patient well or is a highly skillednurse should certainly be considered as important insights into, or indicatorsof, patient distress.Symptoms Are Multidimensional ExperiencesSymptoms are multidimensional experiences that may be evaluated in terms of their specificcharacteristics and impact. 6, 25-28 Symptom multidimensionality is portrayed in Table 3-3. 16, 17 It isnot uncommon for researchers or clinicians to describe a symptom simply by stating that it ispresent. Although prevalence data alone may be useful information, a more detailed assessmentof the characteristics of specific symptoms is usually more helpful, especially in the clinicalsetting.Significant variability has been demonstrated in relation to symptom characteristics. 6, 25-28 Threecrucial variable dimensions are frequency, severity and distress. Although symptom characteristicsare often variable, the proportion of patients who describe a symptom as relatively intenseor frequent usually exceeds the proportion describing it as highly distressing. 28, 29 The frequencydimension does not apply to some symptoms, for example, constipation.44U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau