CAQ-Palliative key terms

The idea that suffering at the end of life includes physical, emotional, social, and spiritual dimensions, so effective relief requires attention to all of them rather than analgesia alone.

A structured interview approach that gathers the patient's physical symptoms, psychological distress, social and family circumstances, and spiritual or existential concerns before agreeing on a care plan.

A discussion that clarifies what outcomes matter most to a patient, given their illness trajectory, and uses those priorities to choose treatments, including decisions to limit burdensome interventions.

An ongoing process of discussing and documenting a person's values and preferences for future care, so that decisions can be honored if they later lose decision-making capacity.

A person appointed in advance, usually through a written directive, to make medical decisions on behalf of a patient who can no longer speak for themselves.

A family member or other designated individual who makes treatment choices for an incapacitated patient, ideally using the patient's known values and previously stated wishes.

A decision standard in which a surrogate chooses what the patient would likely have wanted, based on prior statements and values, rather than what the surrogate personally prefers.

A decision standard used when a patient's wishes are unknown, in which the surrogate weighs benefits and burdens to choose what a reasonable person in that situation would accept.

A clinical judgment that a proposed intervention cannot achieve its intended physiological goal or meaningful benefit for the patient, which may justify limiting or declining that treatment.

The planned discontinuation of interventions such as mechanical ventilation or dialysis, generally considered ethically equivalent to never starting them when consistent with patient goals.

Planned removal of an endotracheal tube in a dying patient, with premedication and ongoing symptom management, to allow natural death when continued ventilation is not desired.

A deliberate, patient-initiated decision to stop oral intake near the end of life, undertaken with palliative support, in order to hasten death in a manner some patients find acceptable.

The natural reduction in fluid intake and resulting dehydration that commonly accompanies the final days of life, often producing less discomfort than clinicians and families fear.

A sudden, severe episode of breathlessness and panic, often in a patient with advanced disease, requiring rapid nonpharmacologic support plus prompt opioid and anxiolytic treatment.

An audible gurgling or rattling sound caused by secretions in the upper airway of a dying patient who cannot clear them; it is often more distressing to families than to patients.

Switching from one opioid to another, or to a different route, using equianalgesic dose tables and then reducing for incomplete cross-tolerance, to improve analgesia or reduce adverse effects.

The dose of one analgesic that is expected to produce roughly the same pain relief as a given dose of another, forming the basis for safe conversion calculations between opioids.

A transient flare of pain that occurs despite otherwise adequate baseline analgesia, often triggered by movement or procedures and treated with a short-acting rescue dose.

Pain arising from injury or dysfunction of the nervous system, often described as burning, shooting, or electric, and typically requiring adjuvants such as gabapentinoids or tricyclics alongside opioids.

A drug whose primary indication is not pain but which relieves specific pain types, such as anticonvulsants for neuropathic pain or corticosteroids for pain from tumor edema.

A mu-opioid agonist widely used for moderate to severe pain and dyspnea; its active metabolites accumulate in renal impairment, so dose reduction or an alternative opioid is needed.

An opioid antagonist used to reverse respiratory depression or oversedation from opioids, titrated cautiously in palliative patients to restore breathing without precipitating severe pain or withdrawal.

The deliberate use of sedating medication, proportional to need, to relieve intolerable symptoms that cannot be controlled otherwise, with the intent of comfort rather than ending life.

An ethical principle holding that an action with a good intended aim, such as relieving pain, may be acceptable even if a foreseeable but unintended harmful outcome, such as hastened death, occurs.

An estimate of the likely course and outcome of a disease, including expected survival and functional trajectory, used to guide treatment choices and timely referral to hospice or palliative care.

The clinical and documentation criteria, including a prognosis of roughly six months or less if the disease runs its usual course, that qualify a patient for the hospice benefit.

A clinician-rated tool scoring ambulation, activity, self-care, intake, and consciousness from 0 to 100 percent, used to describe functional decline and support prognosis and hospice eligibility.

A 0 to 100 scale describing a patient's ability to carry out daily activities and self-care, used to track functional decline and inform prognosis and treatment planning.

The physical, emotional, financial, and social strain experienced by family or friends providing care, which should be assessed and supported as part of the plan of care.

The period of grief and adjustment following a death; hospice programs assess risk and provide structured support to family members during this time.

Persistent, intense grief that remains disabling months after a loss and interferes with functioning, warranting targeted psychotherapy rather than ordinary supportive counseling alone.

An acute, fluctuating disturbance of attention and awareness often caused by medications, infection, or metabolic derangement; it is common near the end of life and frequently reversible or manageable.

Agitation, confusion, and purposeless movement in the final days of life, often multifactorial, managed by treating reversible causes and using antipsychotics or benzodiazepines cautiously.

Restless, distressed behavior that may reflect pain, delirium, dyspnea, urinary retention, or existential distress, so assessment for underlying causes precedes pharmacologic sedation.

Suffering arising from loss of meaning, hope, or connection, or from conflict with religious beliefs, which may respond to chaplaincy involvement and respectful exploration of the patient's concerns.

A coordinated group including physician, nurse, social worker, chaplain, and others who jointly plan and deliver hospice and palliative care, sharing information and responsibilities.

A structured discussion with the patient, family, and team to share information, clarify goals, resolve conflict, and agree on a plan of care, documented for continuity.