ABIM Palliative Care key terms

A concept describing suffering as the sum of physical, psychological, social, and spiritual distress. Effective palliative care addresses all these dimensions rather than treating physical symptoms alone.

Pain arising from actual or threatened damage to non-neural tissue, caused by activation of peripheral nociceptors. It is usually described as aching, throbbing, or cramping and often responds to non-opioid and opioid analgesics.

Pain caused by a lesion or disease of the somatosensory nervous system. It is often burning, shooting, or electric-like and usually responds partially to adjuvants such as gabapentinoids or tricyclic antidepressants rather than opioids alone.

A transient worsening of pain that occurs despite otherwise stable background analgesia. It may be incidental, spontaneous, or related to a procedure and is often managed with short-acting rescue doses.

Changing from one opioid to another to improve analgesia or reduce adverse effects. It requires calculating an equianalgesic dose, reducing for incomplete cross-tolerance, and reassessing frequently.

The dose of one opioid that produces approximately the same analgesic effect as a dose of another opioid. These values guide opioid rotation but require adjustment for incomplete cross-tolerance and patient-specific factors.

A medication whose primary indication is not pain but that relieves pain when used alone or with opioids. Examples include gabapentinoids, tricyclic antidepressants, corticosteroids, and bisphosphonates.

A subjective sensation of uncomfortable or difficult breathing. It is common in advanced illness and is managed with opioids, fan therapy, treatment of reversible causes, and attention to anxiety.

Constipation caused or worsened by opioid therapy through reduced gastrointestinal motility. It does not reliably improve with time, so most patients starting opioids need a scheduled prophylactic bowel regimen.

A scheduled combination of laxatives, stool softeners, and sometimes stimulants used to prevent or treat constipation. In palliative care it is especially important during opioid therapy and in immobile patients.

An acute, fluctuating disturbance of attention and awareness, often with disorganized thinking or perceptual changes. It is common in serious illness, frequently reversible, and requires identifying precipitating causes.

Delirium occurring in the final days or hours of life, often with restlessness, agitation, or somnolence. Treatment emphasizes comfort, caregiver support, and cautious use of antipsychotics or sedatives when distress persists.

A multifactorial metabolic syndrome of involuntary weight loss, muscle wasting, and reduced appetite in advanced illness. It responds poorly to increased nutrition and is managed with symptom relief and family support.

The clinical and personal outcomes a patient values most, used to guide treatment decisions. Discussing goals helps align care with the patient's priorities, especially in serious illness.

An ongoing process of discussing and documenting a person's values, goals, and preferences for future medical care. It prepares patients and families for decisions if the patient loses decisional capacity.

A legal document that records a person's preferences for medical care or names a surrogate decision-maker. It takes effect when the person can no longer communicate or decide.

A portable medical order form for seriously ill patients that records specific treatment preferences such as resuscitation, hospitalization, and artificial nutrition. It is completed with a clinician and travels across care settings.

A person authorized to make health care decisions for a patient who lacks decisional capacity. The surrogate should use substituted judgment, relying on the patient's known values and preferences.

A decision-making standard in which a surrogate chooses as the patient would have chosen, based on the patient's values, goals, and prior statements. It is preferred when the patient's wishes are known.

A patient's ability to understand relevant information, appreciate the consequences of choices, reason about options, and communicate a decision. It is assessed for a specific decision and can fluctuate.

A structured discussion with a patient who has a life-limiting illness about understanding, information preferences, goals, fears, and acceptable trade-offs. It aims to align future care with what matters most.

Suffering related to a disturbance in a person's sense of meaning, purpose, connection, or relationship with the sacred. It may present as hopelessness, guilt, anger, or questions about suffering.

A brief psychotherapeutic intervention for people with serious illness that invites them to reflect on memories, values, and legacy. A generated document is shared with family to support meaning and connection.

A lifelong process of self-reflection, openness, and respect for patients' cultural identities and beliefs. It involves recognizing power imbalances and adapting care rather than assuming cultural competence is complete.

An ethical principle holding that an action with a good intended effect may be permissible even if a foreseeable harmful effect occurs, provided the harm is not the means or intent.

The intentional use of sedating medication to relieve severe refractory suffering in a dying patient. It is distinguished from euthanasia because the intent is symptom relief, not causing death.

The typical course and rate of decline of a disease over time. Recognizing patterns such as cancer, organ failure, and frailty helps clinicians anticipate needs and plan palliative care.

A standardized rating of a patient's functional ability and independence in daily activities, such as the ECOG or Karnofsky scales. It helps estimate prognosis and guide treatment decisions.

A comprehensive care model for people with a limited life expectancy, focused on comfort, quality of life, and support for family caregivers. In the United States it is usually delivered under the Medicare hospice benefit.

Noisy breathing caused by secretions in the upper airway in a dying patient. It is often distressing to families but usually not to the patient; treatment includes repositioning, gentle suction, and reassurance.

Restlessness, distress, or agitated behavior in the final days of life, often related to delirium, pain, or other symptoms. Management includes identifying causes, environmental calm, and medication for comfort.

The period of grief and mourning after a death. Palliative care programs support bereaved families through follow-up, counseling, and recognition of complicated grief.

Persistent, intense grief that impairs functioning for many months after a death. It differs from normal grief in duration and severity and may benefit from targeted psychotherapy.

A deliberate decision by a capacitated patient to stop eating and drinking to hasten death. It raises ethical and legal questions and requires careful assessment, palliative support, and respect for autonomy.

A syndrome of reduced physiologic reserve and increased vulnerability to stressors, often marked by weakness, slowness, low activity, and weight loss. It affects prognosis and palliative care needs in older adults.

The physical, emotional, financial, and social strain experienced by family or friends caring for a seriously ill person. Assessing and supporting caregivers is a core part of palliative care.

A group of professionals from different disciplines, such as medicine, nursing, social work, chaplaincy, and pharmacy, who collaborate to address the many needs of patients and families.

A US Medicare program that pays for hospice care for people with a prognosis of six months or less if the illness follows its usual course. It covers medications, nursing, social work, chaplaincy, and bereavement support.