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barriers, end-of-life, symptom management, symptoms



  1. Jablonski, Anita PhD, RN
  2. Wyatt, Gwen K. PhD, RN


A number of initiatives have been launched in recent years aimed at improving the quality of end-of-life care, particularly in the area of symptom management. Despite these efforts, however, many patients will not experience a peaceful death free of pain and suffering. A number of barriers continue to block efforts to ease symptom burden at the end of life. A conceptual model that helps to identify these obstacles is the Symptom Management Model developed by the faculty at the School of Nursing, University of California, San Francisco. Two components of the model are explored in this article. Discussion of the Symptom Management Strategies dimension of the model focuses on factors related to professional nursing that block effective symptom control. In addition, barriers related to the Environment Domain (ie, physical, social, and cultural context in which a symptom occurs) are also examined for their impact on symptom relief. Healthcare providers are encouraged to use the Symptom Management Model to identify and correct impediments to effective symptom management and reduce patient suffering at the end of life.