Hi. I'm Amos Bailey, the Director of the Masters of Science in Palliative Care, graduate InterProfessional Palliative Care Certificate here at the University of Colorado Anschutz Medical Campus. In this course, we will learn to evaluate, respond, and support patients with distressing non-pain physical symptoms. Research indicates that patients with serious illness experience many different symptoms during the course of their illness. Some of these symptoms may be mild but others compromise quality of life and are a major source of suffering. We cannot review all of these symptoms, but we will review the most common and distressing. In palliative care, we should focus on symptom control and management, as this can improve the quality of life and has the potential to improve survival. Often, the focus has been on treating the underlying disease, the idea being that, if this is cured or controlled, then the physical symptom will go away. It is important to provide patients with the best treatment to control the underlying disease. But with progression of illness, people still suffer from shortness of breath, the weakness of severe congestive heart failure, and COPD and/or anorexia, loss of appetite, and wasting, and weakness with progressive cancer. In a review of patients' reported symptoms and people living with cancer, COPD, congestive heart failure, end-stage renal disease, and dementia or AIDs, common non-pain symptoms included fatigue, weakness, anorexia, nausea, vomiting, shortness of breath or dyspnea, insomnia, confusion and delirium, and constipation. As you can see in this chart, distressing symptoms are very common. In many studies, over 90 percent of people living with an illness at this severity reported at least one particular symptom, and most people will have multiple, bothersome, or distressing symptoms at the same time. Symptoms may flare up. There is also evidence of symptoms clustering such as breathlessness being more common with heart and lung disease, while nausea and vomiting are more common in people living with cancer or renal disease. Patients with dementia are less able to report symptoms, which may lead others to assume they do not have distressing symptoms. Review the table in more detail in the following reading. I will see you soon when we can learn more about routine symptom assessment to help us better understand the patient's experience of living with multiple distressing physical symptoms.