ABFM Palliative Care key terms

Interdisciplinary care that relieves suffering and improves quality of life for patients with serious illness and their families. It is offered at any stage, alongside curative or life-prolonging treatment, and is not limited to people who are dying.

Estimating the likely course and time frame of an illness. Clinicians combine disease type, functional decline, laboratory trends, and clinical experience to guide goals-of-care discussions, hospice referral, and family expectations.

A standardized rating of a patient's functional independence, such as the Palliative Performance Scale or ECOG score. Declining performance status strongly predicts shorter survival and helps determine hospice eligibility and appropriate treatment intensity.

A screening prompt asking whether the clinician would be surprised if the patient died within the next twelve months. A no answer identifies patients who may benefit from palliative care referral or a goals-of-care conversation.

The concept that suffering in serious illness has physical, psychological, social, and spiritual dimensions, all of which must be assessed and addressed for pain to be effectively relieved.

Pain arising from tissue injury or inflammation, described as aching, throbbing, or pressure, and usually responsive to acetaminophen, NSAIDs, and opioids. It includes somatic and visceral subtypes.

Pain caused by damage to or dysfunction of the nervous system, often burning, shooting, or electric, and less responsive to opioids alone. Adjuvants such as gabapentinoids, tricyclic antidepressants, or SNRIs are first-line.

A transient flare of pain occurring against a background of otherwise controlled pain. It may be incident, spontaneous, or end-of-dose, and is treated with short-acting rescue doses of an opioid.

Switching from one opioid to another to improve analgesia or reduce intolerable adverse effects. Rotation requires equianalgesic conversion, a dose reduction for incomplete cross-tolerance, and close monitoring during the transition.

A medication whose primary indication is not pain but that relieves pain in certain conditions, for example gabapentinoids for neuropathic pain, corticosteroids for bone or nerve compression, or antidepressants for chronic pain.

Constipation caused by opioid binding in the gut. Unlike nausea and sedation, tolerance does not develop, so a stimulant laxative is usually started prophylactically and continued for as long as opioids are prescribed.

An opioid antagonist used to reverse respiratory depression and oversedation. In palliative care it is titrated in small doses to restore breathing without fully reversing analgesia or precipitating severe withdrawal and pain.

A distressing sensation of breathlessness. In serious illness, low-dose opioids are first-line for refractory dyspnea, along with fans, positioning, and treating reversible causes; supplemental oxygen helps mainly when hypoxemia is documented.

An acute, fluctuating disturbance of attention and awareness that is common in advanced illness. Because causes are often multifactorial, evaluation for medications, infection, urinary retention, constipation, and pain precedes or accompanies antipsychotic treatment.

A brief validated questionnaire that rates nine common symptoms plus overall well-being on numeric scales. It screens for and tracks symptom burden and response to treatment in palliative care.

An agreed description of what matters most to a patient, such as comfort, independence, time at home, or longevity, used to select treatments and to guide decisions when the patient can no longer speak.

A conversation in which clinician and patient exchange information about options, benefits, and harms, explore the patient's values, and jointly agree on a plan rather than the clinician deciding alone.

A six-step framework for delivering bad news: setting up the conversation, assessing the patient's perception, inviting what they want to know, giving knowledge clearly, responding to emotion with empathy, and summarizing a strategy.

A structured conversation with the patient, when able, and family, often including several team members, to review the illness, share prognosis, clarify values, resolve conflict, and agree on next steps and documentation.

A spiritual history tool that asks about faith or belief, its importance, the person's community, and how care should address spiritual needs. It structures a brief, respectful conversation rather than a religious assessment.

An ongoing self-reflective stance in which clinicians recognize their own cultural assumptions, ask about the patient's values and preferences, and negotiate care rather than assuming one right approach.

An ongoing process of discussing and documenting a person's values and treatment preferences for future incapacity, including a surrogate decision maker and preferences about resuscitation, hospitalization, and artificial nutrition.

A person appointed in advance to make medical decisions for a patient who has lost capacity. The proxy should use substituted judgment, choosing what the patient would have wanted rather than what the proxy prefers.

A clinical judgment that a patient can understand relevant information, appreciate the consequences, reason about options, and communicate a consistent choice. Capacity is task-specific, whereas competence is a legal determination made by courts.

The ethical standard directing a surrogate to choose the treatment the patient would have selected, based on prior statements, values, and known preferences, rather than on what the surrogate personally prefers.

An ethical principle holding that an action intended to relieve suffering may be permissible even if it foreseeably shortens life, provided the death is not intended or the means, and the benefit is proportionate.

A portable medical order form documenting resuscitation, medical intervention, and antibiotic preferences for patients with serious illness. It translates goals of care into actionable orders that are honored across care settings.

A legally regulated practice in some jurisdictions where a terminally ill, decisionally capable adult may request and self-administer a lethal medication. It is distinct from palliative sedation and from euthanasia.

A comfort-focused insurance benefit for people with terminal illness and a prognosis of six months or less if the disease follows its usual course. It funds interdisciplinary home or facility care, medications, equipment, and family bereavement support.

Noisy breathing caused by pooled secretions in the upper airway of an imminently dying patient. It is usually not distressing to the patient; anticholinergic medications and repositioning are used, and deep suctioning is avoided.

The final days or hours of life, marked by decreasing consciousness, mottled skin, cool extremities, irregular breathing, and minimal urine output. Care shifts to comfort, family support, and stopping non-beneficial monitoring and medications.

The proportional use of sedating medication to relieve refractory suffering in the final days of life. It differs from euthanasia because the intent is symptom relief and medication is titrated to comfort.

A group of professionals, including physician, nurse, social worker, chaplain, pharmacist, aide, and others, who collaborate on a shared care plan and meet regularly to address the many dimensions of serious illness.

Family-centered care for children with serious illness, provided alongside curative treatment from diagnosis onward. It addresses symptom control, developmental needs, sibling support, and shared decision making throughout the illness.

Support for families carrying a fetus or newborn with a life-limiting condition. It includes prenatal planning, a birth plan focused on comfort and time with the infant, memory-making, and bereavement care.

Persistent, disabling grief with intense yearning or preoccupation with the deceased lasting beyond twelve months in adults (six months in children) and impairing function. It is distinguishable from normal grief and warrants targeted therapy.

Grief experienced before an expected death, including sadness, worry, and rehearsing life without the person. It can coexist with caregiving strain and may ease adjustment after the death.

The physical, emotional, financial, and social strain experienced by family or friends caring for a seriously ill person. Screening and practical support reduce burnout and help keep patients at home.