Desbiens et al identified a number of symptoms that were burdens for hospitalized patients who are seriously ill. Burdensome symptoms should be targeted for aggressive intervention. The authors are from the Marshfield Clinic and four other American university hospitals.


Scale used for symptom intensity:

(1) not at all severe

(2) moderately severe

(3) extremely severe

For the implementation I will use a 5 point scale (none, minimal, mild, moderate, severe).


Criteria for a burdensome symptom:

(1) severe intensity of any duration

(2) moderate intensity for >=50% of the time


Symptoms that were the most burdensome in the study:

(1) dyspnea

(2) pain

(3) nausea

(4) anxiety

(5) depression

For the implementation I will allow for 2 additional symptoms (total of 7).



• minimum number of burdensome symptoms: 0

• maximum number of burdensome symptoms: 7

• The presence of one or more burdensome symptoms is associated with reduced quality of life.


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