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Communication in palliative medicine: A pilot study of a problem list to capture complex medical information

The Harry R. Horvitz Center for Palliative Medicine, The Harry R. Horvitz Chair in Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Donna S. Zhukovsky, MD, FACP

The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

We developed a one-page, structured problem list to facilitate communication of complex patient information in palliative medicine. The problem list was developed to provide a concise record of the complex problems presented by patients with advanced disease. It was also seen as a mechanism to facilitate interdisciplinary and multidisciplinary communication and continuity of care in the hospital and in the community. One hundred consecutive patients, who were newly referred to our palliative medicine program, were prospectively surveyed to gain clinical experience with the problem list. Ninety patients had cancer diagnoses. The median age was 69 (range 20-90 years), the male to female ratio was 2:1, and the median Eastern Cooperative Oncology Group (ECOG) performance status was 3 (range 0-4). The population was 78 percent Caucasian. The median number of symptoms per patient was 5 (range 0-13), which was similar for cancer and noncancer patients. Overall, gastrointestinal symptoms and pain were the most common symptoms. Pain was more common in cancer patients, and respiratory problems were the most common among noncancer patients. Noncancer patients had better performance status. Based on this experience, we believe a problem list facilitates succinct communication of complex patient information essential to optimal patient care. Proposed modifications are discussed.

Key Words: palliative medicine • symptoms • problem list • cancer • communication

American Journal of Hospice and Palliative Medicine®, Vol. 21, No. 5, 365-371 (2004)
DOI: 10.1177/104990910402100511


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