“Now that You Mention it, Doctor … ”: Symptom Reporting and the Need for Systematic Questioning in a Specialist Palliative Care Unit

AIMS: To determine which symptoms experienced by patients admitted to a specialist palliative care unit are self-reported (SR) and which are only detected with systematic questioning (SQ). METHODS: A retrospective chart review was performed of 50 patients. The admission proforma was reviewed to determine symptoms present, which were SR, and which were only detected upon SQ. RESULTS: An average of 13 symptoms were experienced (SR + SQ) per patient (range, 5-24). Forty-two different symptoms were SR, with an average of 4 per patient (range, 1-10). The most common SR symptoms were pain (72%), bowel disturbance (32%), nausea or vomiting (30%), mobility problems (30%), and loss of appetite (24%). On SQ of 38 common symptoms, there was an average of 8 further symptoms per patient detected (range, 1-18). The most common symptoms detected on SQ were weight loss (66%), fatigue (56%), loss of appetite (48%), mobility problems (42%), edema/ lymphedema (36%), oral symptoms (36%), confusion/memory loss (36%), sleep problems (36%), bowel disturbance (34%), drowsiness (32%), and low mood (28%). CONCLUSION: Patients have many symptoms that are not SR on admission. SQ plays a vital role in the detection of symptoms that may require further assessment or treatment.