Matching the clinical function and symptom status with the expectations of patients with advanced cancer, their families, and health care workers

Continuous accurate assessment is mandatory for palliative care of good quality. One of the major objectives in palliation is to meet the expectations of patient, family members and care givers. While a number of valid tools for assessing symptoms or function are available, there are unfortunately no recognized instruments for assessing expectations. The mismatch of expectations and the actual situation is a major source of distress and conflict. The present paper describes a simple way of visualizing this distress and conflict graphically. In our experience, this method is helpful in raising awareness of and enabling analysis of distress and conflict in patients, family members, and health care workers, It is also useful in the education of students and members of the palliative care team. It is illustrated with reference to four clinical situations.