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Contents
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The ‘WHY’ framework The ‘WHY’ framework
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Does this person have a life-limiting illness? Does this person have a life-limiting illness?
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Global assessment of the person with palliative or supportive care needs Global assessment of the person with palliative or supportive care needs
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Five key considerations Five key considerations
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The life-limiting illness The life-limiting illness
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Intercurrent illnesses Intercurrent illnesses
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Response to disease- or prognosis-modifying therapies Response to disease- or prognosis-modifying therapies
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Change in functional status over time Change in functional status over time
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The person's perception of their future The person's perception of their future
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Further reading Further reading
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Chest pain Chest pain
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of chest pain Acute onset (less than 24 hs) of chest pain
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Subacute onset (1–3 days) of chest pain Subacute onset (1–3 days) of chest pain
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Acute-on-chronic chest pain Acute-on-chronic chest pain
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Abdominal pain Abdominal pain
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of abdominal pain Acute onset (less than 24 hs) of abdominal pain
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Subacute onset (1–3 days) of abdominal pain Subacute onset (1–3 days) of abdominal pain
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Acute-on-chronic onset of abdominal pain Acute-on-chronic onset of abdominal pain
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Further reading Further reading
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Pelvic pain Pelvic pain
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of pelvic pain Acute onset (less than 24 hs) of pelvic pain
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Subacute onset (1–3 days) of pelvic pain Subacute onset (1–3 days) of pelvic pain
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Acute-on-chronic onset of pelvic pain Acute-on-chronic onset of pelvic pain
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Low back pain Low back pain
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of low back pain and … Acute onset (less than 24 hs) of low back pain and …
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Subacute onset of low back pain (1–3 days) Subacute onset of low back pain (1–3 days)
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Acute-on-chronic low back pain Acute-on-chronic low back pain
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Pain in the setting of previous substance misuse Pain in the setting of previous substance misuse
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) Acute onset (less than 24 hs)
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Breathlessness Breathlessness
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of dyspnoea and … Acute onset (less than 24 hs) of dyspnoea and …
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Subacute onset of dyspnoea (1–3 days) Subacute onset of dyspnoea (1–3 days)
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Acute-on-chronic dyspnoea Acute-on-chronic dyspnoea
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Acute confusional state (delirium) Acute confusional state (delirium)
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of confusion and … Acute onset (less than 24 hs) of confusion and …
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Subacute onset (1–3 days) of confusion Subacute onset (1–3 days) of confusion
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Acute-on-chronic confusion Acute-on-chronic confusion
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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All medications All medications
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Sepsis Sepsis
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Hepatic decompensation Hepatic decompensation
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Dehydration Dehydration
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Hypercalcaemia Hypercalcaemia
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Seizures Seizures
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Decreased level of consciousness Decreased level of consciousness
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of decreased level of consciousness and… Acute onset (less than 24 hs) of decreased level of consciousness and…
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Subacute onset (1–3 days) of decreased levels of consciousness and… Subacute onset (1–3 days) of decreased levels of consciousness and…
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Acute-on-chronic changes in level of consciousness Acute-on-chronic changes in level of consciousness
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Agitation Agitation
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of agitation Acute onset (less than 24 hs) of agitation
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Subacute onset (1–3 days) of agitation Subacute onset (1–3 days) of agitation
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Acute-on-chronic anxiety Acute-on-chronic anxiety
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With a history of anxiety: anxiety states With a history of anxiety: anxiety states
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Diarrhoea Diarrhoea
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of diarrhoea Acute onset (less than 24 hs) of diarrhoea
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Subacute onset (1–3 days) of diarrhoea Subacute onset (1–3 days) of diarrhoea
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Acute-on-chronic diarrhoea Acute-on-chronic diarrhoea
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Nausea (and vomiting) Nausea (and vomiting)
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of nausea Acute onset (less than 24 hs) of nausea
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Sub-acute onset (1–3 days) of nausea Sub-acute onset (1–3 days) of nausea
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Acute-on-chronic nausea Acute-on-chronic nausea
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Unheralded vomiting Unheralded vomiting
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of vomiting Acute onset (less than 24 hs) of vomiting
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Subacute onset (1–3 days) of unheralded vomiting Subacute onset (1–3 days) of unheralded vomiting
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Fever Fever
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Onset of symptom Onset of symptom
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Acute onset (less than 24 hs) of fever and… Acute onset (less than 24 hs) of fever and…
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Sub-acute onset (1–3 days) of fever Sub-acute onset (1–3 days) of fever
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Acute-on-chronic fever Acute-on-chronic fever
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Can you modify anything contributing to the symptom? Can you modify anything contributing to the symptom?
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What underlying factors cannot be improved? What underlying factors cannot be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological intervention Pharmacological intervention
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Further reading Further reading
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Care in the last hours of life Care in the last hours of life
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Diagnosing dying Diagnosing dying
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What underlying factors can be improved? What underlying factors can be improved?
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Symptomatic treatment Symptomatic treatment
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Non-pharmacological intervention Non-pharmacological intervention
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Pharmacological interventions Pharmacological interventions
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Crisis medications Crisis medications
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Further reading Further reading
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1 Frequently encountered symptoms
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Published:November 2006
Cite
Extract
The ‘WHY’ framework*
Clinical decision-making in palliative care—fundamental questions that underlie good palliative practice for health professionals.
Does this person have a life-limiting illness?
Every health professional involved in the care of this person should satisfy themselves that this person has a progressive life-limiting illness. Admission to a palliative care service without a life-limiting illness has occurred, at times with disastrous consequences. There have also been examples where, in the presence of a life-limiting illness, a new intercurrent problem has been wrongly attributed to the life-limiting illness.
The supportive care needs of people who are seriously unwell with a potential life-limiting illness are also considered in this book.
The question ‘Why?’ arises when someone's clinical course does not reflect the known course of the illness. Therefore, knowing the natural history of this illness is the foundation on which the answer to this question is built. Is today's new symptom:
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