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 SymptomsSymptom Assessment Methodology and InstrumentsA wide array of instruments is available for the assessment of symptoms. Numerous methodsand instruments 26 picas have been validated for the assessment of symptoms, including instruments forthe assessment of pain and depression. However, few instruments have been validated for manyof the other symptoms that are prevalent in advanced HIV-related disease, such as anorexia orchange in appearance. Although it is beyond the scope of this chapter to review all of the instrumentsavailable for the assessment of symptoms, broadly these instruments fall into two categories,as follows:• Symptom-specific instruments• Instruments for the assessment of multiple symptomsSome instruments are more applicable in the research setting than in the clinical setting. Whenconsidering the use of instruments in the clinical setting, many factors must be considered, aspresented in Table 3-6. It is not always crucial for patients to complete a written instrument. Inmany cases, a verbal interaction between the patient and clinician that elicits a “measure” of asymptom can provide a useful report. For example, the clinician may ask, “Can you tell me on ascale of 0 to 10 what level your pain is at right now? Zero refers to no pain and 10 the worstpossible pain.”IIITable 3-6: Considerations for Symptom Measurement in Clinical SettingsPatient-related factorsCan the patient comprehend the method of measurement,and what is the impact of the patient’s cognitive state onhis or her report?How willing and able is the patient to provide reports and/or complete an instrument?Are there cultural and language barriers that have impacton the symptom report?Is it possible that the patient may be reluctant to report aspecific symptom?Is it important, in this particular patient, to assess onesymptom or multiple symptoms?Do the patient’s descriptions for the symptom accuratelymatch those used in the method or instrument selectedfor reporting? (This is related to instrument validity.)Symptom-specific factorsWhich symptoms and dimensions of symptoms need to beassessed, from the patient’s perspective? Usually “distress”or “bothersomeness” is important to consider.What symptoms or signs are crucial factors to monitor?E.g., in certain cases fever may be a “vital sign” andwarrant some priority in assessment.Is the symptom important to detect and likely to gounnoticed? E.g., pain and confusion.U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 61