Palliative Care Guidelines
Jimmy S Bilimoria Foundation



The aim of this guideline is to provide a tool for systematic and comprehensive assessment of symptoms in patients who can self-report. In those who can’t, this can still be used as a guide to gather information regarding the symptom from the care-giver. Table 1 provides an acronym OPQRSTUV to help in symptom assessment.


  • The tool is a guide and all components of the tool may apply for the assessment of all symptoms
  • The relevant sections of the tool for each symptom should be used
  • Good symptom assessment is the first step to effective symptom management
  • Appropriate physical examination should be done to complete clinical assessment
Table 1: Adapted Symptom Assessment using Acronym OPQRSTUV*
OnsetWhen and how did it begin? (acute / insidious)
How long does it last? (duration) How often does it occur? (frequency)
Palliating/ProvokingWhat brings it on? What makes it better? What makes it worse?
QualityWhat does it feel like? Can you describe it? (aching/ throbbing/ burning etc.)
Region/RadiationWhere is it? Does it radiate? If so where to?
SeverityWhat is the intensity of this symptom (on a scale of 0 to 10 with 0 being none and 10 being worst possible)?
Right now? At best? At worst? On average?
How bothered are you by this symptom?
Are there any other symptoms that accompany this symptom?
Does it affect sleep?
Treatment What medications and treatments are you currently using?
How regular are you with the medications/treatment?
How long have you been taking these medications?
How effective are they?
Do you have any side effects from the medications and treatments?
What medications and treatments have you used in the past?
Understanding/Impact What do you believe is causing this symptom?
How is this symptom affecting you and/or your family?
How else is the symptom causing distress?
ValueWhat is your goal for this symptom?
What is your comfort goal or acceptable level for this symptom (on a scale of 0 to 10 with 0 being none and 10 being worst possible)?
Are there any other views or feelings about this symptom that are important to you or your family?

* Adapted from “Hospice Palliative Care Program – Symptom Guidelines” (see References).


Palliative Care Guidelines