ABEM HPM key terms

The concept that suffering at the end of life arises from interlocking physical, psychological, social, and spiritual sources, so effective relief requires assessing and addressing all domains rather than treating physical symptoms alone.

Pain caused by actual or threatened damage to non-neural tissue, produced by activation of peripheral nociceptors; it is typically described as aching, throbbing, or pressure-like and usually responds to opioids and non-opioid analgesics.

Pain caused by a lesion or disease of the somatosensory nervous system, often burning, shooting, or electric in quality; it frequently responds to adjuvants such as gabapentinoids or tricyclics in addition to opioids.

A transient flare of pain that occurs despite otherwise adequate around-the-clock analgesia; it may be incident, triggered by movement, spontaneous, or end-of-dose, and is treated with short-acting rescue doses.

The dose of one opioid that produces approximately the same analgesic effect as a standard dose of another; equianalgesic tables guide safe opioid rotation while accounting for incomplete cross-tolerance by reducing the calculated new dose.

Constipation caused or worsened by opioid therapy through reduced gut motility; it does not reliably improve with continued opioid use, so prophylaxis with a stimulant laxative is recommended when opioids are started.

A medication whose primary indication is not pain but that relieves pain when added to an analgesic regimen, such as gabapentinoids or tricyclics for neuropathic pain or corticosteroids for bone pain.

A subjective sensation of breathing discomfort that may occur with or without hypoxemia; management includes treating reversible causes, opioids, fans or airflow, and anxiolytics when anxiety contributes.

An acute, fluctuating disturbance of attention and awareness often caused by medications, infection, metabolic derangement, or organ failure; it is common near death and managed by treating causes, environmental measures, and antipsychotics when needed.

A multifactorial syndrome of involuntary weight loss, muscle wasting, and reduced appetite driven by systemic inflammation and tumor metabolism; it does not reverse with forced feeding and is managed with appetite stimulants and family support.

Mechanical or functional blockage of the intestine caused by advanced cancer or its treatment; symptoms include vomiting, pain, and distension, and management may include decompression, antisecretory drugs, corticosteroids, and symptom-focused care.

Audible gurgling or rattling produced by pooled oral and bronchial secretions in a dying patient who cannot clear them; it is often distressing to families but usually not to the patient, and treatment includes repositioning and antisecretory medications.

The patient's prioritized desired outcomes and acceptable trade-offs for medical treatment, shaped by values, prognosis, and family concerns; they guide decisions about life-sustaining treatment, hospitalization, and comfort-focused care.

Estimating the likely course and survival of a serious illness using disease-specific data, performance status, and clinical judgment; it supports goals-of-care discussions and hospice eligibility decisions while acknowledging uncertainty.

A screening question asking whether the clinician would be surprised if the patient died within the next year; a no answer identifies patients who may benefit from palliative care or hospice referral.

A standardized rating of a patient's ability to carry out daily activities and self-care, such as the Palliative Performance Scale or ECOG score; lower scores predict shorter survival and greater care needs.

The deliberate organization of patient care activities among multiple clinicians, settings, and services to ensure continuity, avoid duplication, and align treatment with the patient's goals; it is central to palliative care.

An ongoing process of discussing and documenting a person's values, goals, and preferences for future medical care, ideally before a crisis; it prepares patients and surrogates to make in-the-moment decisions.

A legal document that records a person's preferences for future medical treatment or names a surrogate decision-maker; it takes effect when the person loses decisional capacity and guides clinicians and families.

A legal document in which a person appoints a surrogate to make health care decisions if the person becomes unable to do so; the surrogate should follow the patient's known values and wishes.

A portable medical order form, completed with a clinician, that translates a seriously ill patient's preferences into actionable orders for resuscitation, medical interventions, and comfort care across care settings.

A six-step framework for delivering bad news: setting up the interview, assessing perception, obtaining invitation, giving knowledge, addressing emotions with empathy, and summarizing strategy and follow-up.

A patient's ability to understand relevant information, appreciate the consequences of choices, reason about options, and communicate a consistent choice; it is decision-specific and assessed clinically rather than by diagnosis alone.

Persistent, intense grief that remains disabling beyond expected norms and interferes with daily functioning; it may warrant targeted psychotherapy and is distinguished from normal bereavement and major depression.

A structured inquiry into a patient's beliefs, sources of meaning, and spiritual or religious practices that affect coping and care preferences; tools such as FICA help clinicians address distress and connect patients with chaplaincy.

A lifelong stance of self-reflection and openness to patients' cultural identities, values, and power differences; it encourages clinicians to ask rather than assume and to adapt care to the patient's context.

The final phase of life marked by progressive decline such as reduced consciousness, minimal intake, mottling, and irregular breathing; care shifts to comfort, family support, and anticipatory guidance about expected changes.

Restlessness, moaning, or distressed behavior in a dying patient, often multifactorial from delirium, pain, urinary retention, or existential distress; management includes treating reversible causes and cautious symptom-focused medications.

The planned discontinuation of interventions such as mechanical ventilation, dialysis, or vasopressors after determining that they no longer align with the patient's goals; comfort care and family support continue throughout.

The ethical principle that an action intended to relieve suffering may be permissible even if it foreseeably hastens death, provided the bad effect is not intended and is proportional; it is often invoked for opioid or sedative use near death.

A person authorized to make health care decisions for a patient who lacks capacity, ideally chosen by the patient in advance; the surrogate should use substituted judgment or, if wishes are unknown, the patient's best interests.

A Medicare benefit covering palliative care for patients with a prognosis of six months or less if the disease runs its usual course, including interdisciplinary services, medications, and bereavement support, with certification requirements.

A collaborative group of physicians, nurses, social workers, chaplains, aides, and therapists who coordinate hospice or palliative care; shared goals and regular communication support whole-person care for patients and families.

A hospice level of care for symptom crises that cannot be managed at home, providing around-the-clock skilled nursing and medical management in a facility; it is time-limited and reimbursed at a higher daily rate.

A standardized set of data items submitted to Medicare for each hospice admission and discharge; it supports quality reporting on measures such as pain screening, dyspnea treatment, and care preferences.

A clinician's certification that a hospice patient has a prognosis of six months or less if the illness follows its expected course; it is required for Medicare hospice eligibility and must be recertified at specified intervals.