[Symptom monitoring by patients with a psychiatric disorder in palliative care]

Hardly any research has been conducted into systematic symptom monitoring in palliative care for patients with a psychiatric disorder.

To gain insight into the usefulness of the Utrecht Symptom Diary (USD) and the symptom burden of patients with a psychiatric disorder in the palliative phase.

A pragmatic retrospective study using completed USDs by patients (USD-P) and/or caregivers (USD-Z) at the palliative unit and three clinical departments of geriatric psychiatry of GGz Centraal, from October 2011 to January 2018. Analysis was performed using completed USDs, from 3 months to 14 days before death and ≤ 14 days before death. The first measurement was used in both periods. Primary outcomes: prevalence of symptoms (score > 0) and clinical relevance of symptoms (score > 3).

50 USD’s from 38 patients were included, 9 USD-Ps and 41 USD-Zs were analysed. Self-reporting was usually not possible due to psychotic experiences, forms of denial, difficulty with concentration, weakness or fatique. Fatigue and loss of appetite were the most common in USD-Ps and USD-Zs. Fatigue reached most often clinically relevant intensity in USD-Ps and USD-Zs.

If the patient cannot fill in the USD-P, the USD-Z can be an alternative to systematically monitor symptoms. Application of the USD-Z requires good observation and awareness of differences in interpretation between healthcare providers and patients in a target group that has difficulty in expressing complaints clearly. Psychical symptoms are reported more often as clinically relevant than psychological symptoms. Fatigue is the most frequently and most unequivocally scored by patients and healthcare providers in terms of presence and clinically relevant intensity.