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• Impact of Specific Therapies on Each SymptomClarify the impact of therapies on each symptom. Especially with palliativeinterventions, it is crucial in the process of symptom assessment to investigate26 picasthe impact of specific therapies on each symptom to ascertain the efficacy ofthese therapies. Detailed questioning may be needed to clarify whichmedications or treatments a patient has tried and how well they relieved thesymptom. (For example, with the symptom of pain, did pain medicationsprovide you with any relief, and if yes, how much relief? For this question, apain scale can help the patient to report on a scale of 0 to 10 his or her painlevel before the medication and pain level after the medication.)It is also important to ascertain why therapies may have been abandoned.Were they ineffective, too expensive, unavailable, associated with side effects,or were there other reasons?• Impact of the Symptom(s) on the Patient’s Quality of LifeA symptom can produce many adverse effects on quality of life (see Table 3-3).The direct and indirect consequences of symptoms can exacerbate physical,psychosocial, spiritual, and financial burdens produced by the disease itself.Pain, for example, can restrict physical functioning or worsen depression andanxiety and interfere with a patient’s ability to interact socially. Attentionmust extend beyond symptom control to the impact of symptoms on the overallquality of the patient’s life.The Brief Pain Inventory (BPI) is a measurement tool that uses standardizedquestions to explore the impact of a symptom (see Figure 3-3). 33 See Figure4-5 in Chapter 4 for the BPI Short Form. Question 23 on the BPI provides agood example of the kind of questions that providers should ask whenexploring the impact of almost any symptom. Also, questioning should addressside effects and costs of therapy. The latter must be included in assessment sothat a feasible treatment plan can be developed.IIISystems ReviewA systems review is an important aspect of assessment. Especially when a patient is experiencingmultiple symptoms, it is not uncommon for him or her to overlook reporting a bothersomeproblem. For this reason, and because unexpected minor symptoms may provide important diagnosticclues, it is prudent for clinicians to conduct a through systems review.HistoryThe patient’s history of other medical, surgical or psychiatric problems is important to elicit.These problems can, of themselves, contribute to distress, impact potential treatment strategies,and cause symptoms. This aspect of the historytaking should include a review of all relevantpast medical, surgical and psychiatric problems.U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 51