Symptom burden at the end of life: Hospice providers' perceptions

To describe symptom prevalence, frequency and severity among hospice patients, from the perspective of hospice providers, a cross-sectional study was conducted among 16 hospices participating ist the Population-based Palliative Care Research Network (PoPCRN). Hospice staff estimated symptom presence, frequency, and severity, using the Memorial Symptom Assessment Scale. Among the 348 patients (median age 78 years, 55 % female, 55 % cancer diagnosis), the most common symptoms noted by hospice staff were lack of energy (83 %), pain (76 %), lack of appetite (63 %), drowsiness (61 %), difficulty concentrating (60 %), and sadness (51 %). When present, lack of energy was rated by hospice providers as both frequent (75 % "frequently" or "almost constantly") and severe (46 % "severe" or "very severe"). Symptoms varied by care setting and by diagnosis. Hospice staff often Inched sufficient information to rate potentially important symptoms, such as problems with sexual interest or activity (63 %), change in self image (30 %), and worrying (26 %). This study identifies a significant burden of unrelieved symptoms among hospice patients, suggesting a need for more widespread institution of symptom management strategies with proven effectiveness and additional investigation into treatment of common symptoms for which few effective treatment strategies are known. J Pain Symptom Manage 2001: 21:473-480 (C) U.S. Cancer Pain Relief Committee, 2001.