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

To describe symptom prevalence, frequency and severity among hospice patien ts, from the perspective of hospice providers, a cross-sectional study was conducted among 16 hospices participating ist the Population-based Palliati ve Care Research Network (PoPCRN). Hospice staff estimated symptom presence , frequency, and severity, using the Memorial Symptom Assessment Scale. Amo ng the 348 patients (median age 78 years, 55 % female, 55 % cancer diagnosi s), the most common symptoms noted by hospice staff were lack of energy (83 %), pain (76 %), lack of appetite (63 %), drowsiness (61 %), difficulty co ncentrating (60 %), and sadness (51 %). When present, lack of energy was ra ted by hospice providers as both frequent (75 % "frequently" or "almost con stantly") and severe (46 % "severe" or "very severe"). Symptoms varied by c are setting and by diagnosis. Hospice staff often Inched sufficient informa tion to rate potentially important symptoms, such as problems with sexual i nterest 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 symp tom management strategies with proven effectiveness and additional investig ation into treatment of common symptoms for which few effective treatment s trategies are known. J Pain Symptom Manage 2001: 21:473-480 (C) U.S. Cancer Pain Relief Committee, 2001.