Common symptoms of advanced disease

Using the scale, evaluate each of following symptoms: (0=none, 10=worst possible)

  • Pain
  • Shortness of breath/dyspnea
  • Nausea
  • Lack of appetite
  • Constipation
  • Tiredness
  • Drowsiness
  • Depression
  • Anxiety

Note about pain assessment:

  • identify site(s), causes, severity, and impact on function, mood and quality of life.
  • pain is a physical and emotional experience and can be influenced by multiple other factors.

Note about dyspnea assessment: it can’t be assessed by the respiratory rate or the oxygen saturation. Ask the patient if they feel short of breath.

Talk tip: if the patient has many symptoms, ask which symptom is bothering them the most, and manage that symptom as the top priority.

CAM tool for Delirium Assessment

The Confusion Assessment Method enables you to determine if your patient has delirium.

A diagnosis of delirium requires:

  • acute onset and fluctuation
  • inattention
  • disorganized thinking or altered consciousness

Acute onset and fluctuation

Is there evidence of an acute change in mental status from baseline?

Does the abnormal behaviour:

  • come and go
  • fluctuate during the day
  • increase/decrease in severity


Does the patient

  • have difficulty focusing attention?
  • become easily distracted?
  • have difficulty keeping track of what is said?

Disorganized thinking

Is the patient’s thinking disorganized or incoherent, i.e. does the patient have:

  • rambling speech or irrelevant conversation?
  • unpredictable switching of subjects
  • unclear or illogical flow of ideas

Altered consciousness

Overall, what is the patient’s level of consciousness:

  • alert (normal)
  • vigilant (hyperalert)
  • lethargic (drowsy but easily roused)
  • stuporous (difficult to rouse)
  • comatose (unrousable)

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