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Physical, psychological, emotional, and spiritual distress is common among patients living with fatal illness, and patients commonly fear protracted and unrelieved suffering. Health care providers help reassure patients that distressing symptoms are regularly anticipated, prevented and, when present, treated.

Symptom treatment should be based on etiology when possible. For example, vomiting due to hypercalcemia requires different treatment from that due to elevated intracranial pressure. However, diagnosing the cause of a symptom may be inappropriate if testing is burdensome or risky or if specific treatment (eg, major surgery) has already been ruled out. For dying patients, comfort measures, including nonspecific treatment or a short sequential trial of empiric treatments, often serve patients better than an exhaustive diagnostic evaluation.

Because one symptom may have many causes and respond differently to treatment as the patient’s condition deteriorates, the clinical team must monitor and reevaluate the situation frequently. Drug overdosage or underdosage is harmful, and both become more likely as worsening physiology causes changes in drug metabolism and clearance. Prudent reevaluation and appropriate discontinuation of chronic medications is warranted. When survival is likely to be brief, symptom severity frequently dictates initial and ongoing treatment. 

More on symptoms and symptom management:

• Pain
• Dyspnea
• Anorexia
• Nausea and Vomiting
• Constipation
• Pressure Injuries
• Delirium and Confusion
• Frailty, Dementia, and Neuromuscular Diseases
• Depression and Suicide
• Stress and Grief

About the book: First published in 1899 as a small reference book for physicians and pharmacists, The Merck Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers.