The model of unpleasant symptoms, also known as the PALL (pronounced “pall”) model, is a framework for assessing and managing symptoms that are often experienced by individuals with advanced illness or terminal conditions. It is based on the idea that the presence of certain unpleasant symptoms, such as pain, anxiety, and fatigue, can significantly impact a person’s quality of life and overall well-being.
According to the PALL model, an assessment tool must contain the following elements in order to effectively evaluate and manage unpleasant symptoms in individuals with advanced illness:
A comprehensive list of symptoms: The assessment tool should cover a wide range of symptoms that may be experienced by individuals with advanced illness, including physical symptoms such as pain, fatigue, and shortness of breath, as well as psychological and social symptoms such as anxiety, depression, and loneliness.
A clear and consistent definition of each symptom: The assessment tool should provide a clear and concise definition of each symptom, as well as guidelines for identifying and measuring the severity of each symptom. This will help to ensure that the assessment is consistent and reliable across different healthcare settings and providers.
A method for evaluating the impact of each symptom on the individual: The assessment tool should include a way to evaluate how each symptom is affecting the individual’s quality of life, functional ability, and overall well-being. This could include using standardized assessment scales or asking the individual to rate the impact of each symptom on a scale from 0 to 10.
A plan for managing each symptom: The assessment tool should include a plan for managing each symptom, including identifying appropriate treatment goals and strategies, monitoring progress, and adjusting the treatment plan as needed. This may involve using pharmacological and non-pharmacological interventions, as well as coordinating care with other healthcare professionals and community resources.
A system for ongoing assessment and review: The assessment tool should include a system for ongoing assessment and review, including regularly scheduled check-ins with the individual and their healthcare team to assess symptom severity and evaluate the effectiveness of the treatment plan.
The PALL model emphasizes the importance of addressing and managing unpleasant symptoms in individuals with advanced illness in order to improve their quality of life and overall well-being. An effective assessment tool must cover a wide range of symptoms, provide clear definitions and guidelines for measurement, evaluate the impact of each symptom on the individual, include a plan for managing each symptom, and have a system for ongoing assessment and review.
According to the model of unpleasant symptoms, an assessment tool must contain the following. First, the instrumentmust have a provision for the signs, which are physiological, psychological and situational. Psychological factors include all those stimuli that affect the state of the mind example, mood,which is a critical sign in patients with bipolar disorder (Chatani et al., 2021). Moreover, patients could experience physiological symptoms that present secondary to an alteration of the normal physiological functions of the body, which include an increase in heartbeat secondary to adrenaline surge or a decrease due to the parasympathetic action of the vagus nerve supplying the heart. In addition, the other cluster contains situational symptoms resulting from experiencing a stimulus during specific periods and are short-term. The situational symptoms include loss of appetite and sadness (Chatani et al., 2021).
Secondly, after identifying the signs, the tool must give a provision for assessing the factors that influence the symptoms. Factors influencing symptoms include aggravating and relieving factors. Aggravating factors refer to those activities that when a patient engages in, they worsen the presenting symptoms; a good example is the pain that comes with a peptic ulcer patient staying hungry for a long. In this case, the hunger worsens the situation by the patient feeling much pain. Relieving factors, on the other hand, consists of activities that comfort the patient; a good example is the relief of headache by sleep. Often, patients have perceived relieving factors before coming to the hospital. Lastly, performance outcome is critical as it will determine health-seeking behaviors. Primarily, when symptoms impair the performance of patient routines, the result will be seeking care to restore performance capacity (Peterson & Bredow, 2020).
