The approach to evaluating dyspnea in terminally ill patients is different
from other clinical settings because almost all of patients in palliative care
have known incurable advanced diseases which clearly contribute to many of their
symptoms including dyspnea. New or worsening dyspnea warrants looking for the
causes with the aim of improving the patient's quality of life. The decision
to pursue aggressive workups or interventions should carefully be weighed against
the patient’s dying trajectory and the goals of care.
Evaluation of Dyspnea
Chronicity
Is the patient constantly breathless or is the breathlessness precipitated
by certain activities?
When did the patient first notice being breathless?
Intensity
Subjective
How does the patient rate the intensity of dyspnea?
Consider using self report measures like the Visual Analog Scale
or the numerical scale (Can you please rate your breathlessness on
a scale of 0-10, with '0' being no breathlessness and '10' being the
worst breathlessness you have ever had in your life?) (CF-10) similar
to pain assessment.
Objective
Intensity of dyspnea in terminally ill patients can be assessed by
bedside observation (e.g. unable to talk, or eat uninterruptedly for breath)
and by caregiver reports.
