6. Symptom management

Engage with all multidisciplinary team members to provide quality symptom management

Timely, effective, best-practice symptom management is fundamental in the provision of quality end of life and palliative care and must include engagement between primary healthcare providers, general practitioners, end of life and palliative care specialists and all multidisciplinary team members.

Action

Clear processes are in place to ensure there is provision of optimal, best practice physical, spiritual and psychological symptom management, as agreed by care providers, the person with the life-limiting illness, their family and carers. Processes are in place to review, respond and escalate if required, including case conferencing modalities.

Evidence

Appropriate symptom management is crucial to the health outcomes and experience of the person receiving care, their family and carers.

Considerations and resources

Matters regarding appropriate medication use, non-pharmacological considerations and rationalising treatments are important.

Useful resources can be found on the NSW Clinical Excellence Commission website, which includes the Last Days of Life toolkit, Medication prescribing for symptom management – Anticipatory Prescribing Guide and Symptom Management Flowcharts.

Resources

Comfort Observation and Symptom Management Chart (Adult)

Provides tailored individual symptom and comfort assessment and management for patients when their death is expected, as well as support to families and carers in managing symptoms.

Clinical Excellence Commission | Clinical tool | 2017

Last Days of Life Toolkit: Family/carer information regarding care in the last days of life

An information sheet for family and carers around what to expect when their loved one is dying.

Clinical Excellence Commission | Information | 2016

Last Days of Life Toolkit: Family/carer information regarding medications in the last days of life

An information sheet for family and carers around what to expect from medications, administered when their loved one is dying.

Clinical Excellence Commission | Information | 2016

Last Days of Life Anticipatory Prescribing Recommendations for in-patient setting (Adult)

An information resource for clinicians regarding anticipatory prescribing of medications in the last days of life.

Clinical Excellence Commission | Clinical tool | 2017

Medication prescribing

Flowcharts that assist in the assessment and management of the five symptoms commonly experienced by patients in the last days of life.

Clinical Excellence Commission | Clinical tool | 2017

HealthPathways in Pallliative Care and Advance Care Planning

Clinical tools which are designed and written for use during a consultation, that provides clear and concise guidance for assessing and managing a patient with a particular symptom or condition.

End of Life Directions for Aged Care | Toolkit | 2020

Palliative Care Outcomes Collaboration: Assessment forms

Symptom assessment tools designed to help clinicians identify and manage common symptoms at end of life.

University of Wollongong | Clinical tool | 2021

Video resources

Cachexia and anaemia: what action is needed?

A discussion of cachexia and anaemia, their symptom management and support for patients and their families.

Dr Jan Maree Davis Medical Director, Palliative Care Service, South Eastern Sydney Local Health District (Southern Sector)

Cancer pain

How to assess, manage, and deal with the side effects of pain.

Prof Melanie Lovell Senior Staff Specialist, Palliative Care Centre for Learning and Research in Palliative Care, HammondCare

Cancer rehabilitation

A discussion of the rehabilitation needs and options following acute cancer treatment.

A/Prof Andrew Cole Chief Medical Officer, HammondCare, Senior Consultant Rehabilitation Medicine Physician, Greenwich Hospital

Hypercalcaemia in malignant disease and palliative care emergencies

Diagnosis, treatment and considerations for management.

Dr Jan Maree Davis Medical Director, Palliative Care Service, South Eastern Sydney Local Health District (Southern Sector)

Managing neuropathic pain

An examination of neuropathic pain: the distinctive features, assessment techniques and treatment recommendations.

Prof Melanie Lovell Senior Staff Specialist, Palliative Care, Centre for Learning and Research in Palliative Care, HammondCare

Managing nausea and vomiting

Nausea and vomiting are common symptoms in palliative care and have a significant impact on patients’ quality of life.

Dr Bridget Johnson Staff Specialist, Palliative Care, Greenwich Hospital

Nutrition and palliative care

A conversation about the role of a dietitian, of nutrition and the aim of nutritional management in palliative care and in terminal care.

Melissa Scattergood Senior Clinical Dietitian, Royal North Shore Hospital

Pain management

Dr Robyn Keall, Nurse Practitioner discusses the main causes, types, assessments and treatment of pain. Robyn also gives a clear explanation of opioid conversions.

Robyn Keall Nurse Practitioner, Community Palliative Care, Neringah HammondCare

Palliative care and dementia

A discussion about how, why and when to consider palliative care as part of dementia care.

Dr Elspeth Correy Supportive and Palliative Medicine Consultant, Crown Princess Mary Cancer Centre Westmead, Cancer Services, Blacktown and Mt Druitt Hospitals

Respiratory symptoms and managing secretions in end of life care

Respiratory symptoms are common at the end of life regardless of underlying cause of illness.

Dr Caitlin Sheehan Staff Specialist, Palliative Care, St George Hospital and Calvary Health Care Kogarah

Speech pathology and palliative care

An overview of the role of the speech pathologist in palliative care and their importance in maintaining quality of life for patients.

Prudence Gourley Speech Pathology Manager, Macquarie Health Speech and Hearing Clinic, Macquarie University

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