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 Symptomsdeveloped for use in assessing the symptoms of patients receiving palliative care. 64 The ESAS,Figure 3-7, has been shown to be a valid instrument in cancer populations. 65 In addition toassessing specific symptoms, it contains a “distress” score that tends to reflect physical wellbeing.Additional26 picasstudies are needed to confirm its value in patients with HIV-related illness.The Memorial Symptom Assessment Scale (MSAS) 6 is a validated, patient-rated measure thatprovides multidimensional information about a diverse group of common symptoms (see Figure3-1). This instrument assesses 32 physical and psychological symptoms in terms of intensity,frequency and distress. The MSAS has been used in research studies of patients with advancedHIV-related illness and has been modified for the pediatric setting. 3, 5, 44 Although this is a mosthelpful measure in research settings, its utility in the routine clinical setting may be limited.Recent research has, however, explored the role of an MSAS short version (Figure 3-8) that maybe more useful in the clinical setting. 7Holzemer, et al., recently published research to validate a sign and symptom assessment tool forassessing the intensity of HIV-related symptoms. 66 The current version is a 26-item scale. Thisinstrument is also likely to be used in the research setting; however, clinicians may wish toconsider its clinical applications.IIIUsing Signs to Monitor SymptomsSome clinical signs may be useful indicators of symptoms and therefore it may be helpful tomonitor these routinely in certain clinical settings. For example, the monitoring of patient temperatureor the frequency of bowel movements and/or emesis may be useful routine methods ofdetecting—or even anticipating and preventing—symptoms that relate to these signs (e.g.,sweats, chills, abdominal pain, and nausea).In summary, measurement has a key role in the assessment of symptoms. Although measuresfrequently have limitations, if clinicians remain aware of these limitations the measurement ofsymptoms is likely to enhance their ability to effectively monitor and treat patient distress.CONCLUSION■ Systematic symptom assessment is a foundation of clinical practice and is crucial in treatingHIV-related disease. Careful and meticulous clinical assessment should elicit the patient’sperception of distressing symptoms and the pathophysiology responsible for each symptom. Acomprehensive assessment will facilitate the development of a treatment plan that can focus ontreating reversible pathologic processes, alleviating distress, and promoting quality of life.U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 65