1. Pharmacologic Symptom Management

The primary goal of pharmacotherapy in comfort care is to optimize drug therapy to relieve dyspnea, anxiety, agitation, and pain while minimizing adverse effects like excessive sedation and hemodynamic compromise.

2. Non-Pharmacologic Interventions

First-line comfort measures often involve simple, low-risk strategies that can be highly effective and should be implemented for all patients receiving comfort-focused care.

• For Dyspnea Relief: A hand-held fan directed at the face can stimulate the trigeminal nerve, reducing the sensation of breathlessness. Positioning the patient to sit upright or lean forward with arm support can also ease the work of breathing.
• For Relaxation: Guided imagery, deep-breathing exercises, music therapy, and aromatherapy can significantly reduce anxiety and promote a sense of calm.

3. Prevention of Iatrogenic Complications

Proactive care is essential to prevent complications that can cause further discomfort, such as pressure injuries and symptoms of dehydration.

A. Pressure Injury Prevention

Immobile patients are at high risk for skin breakdown. Key preventive measures include:

• Repositioning the patient at least every 2 hours.
• Using pressure-reducing surfaces like high-density foam mattresses or alternating-pressure air beds.
• Conducting daily skin inspections, with special attention to bony prominences.
• Applying cushions or pillows to offload pressure points.

B. Dehydration Management

While aggressive IV hydration is typically avoided, managing thirst and dry mouth is a key comfort goal.

• Oral Care: Frequent mouth care with swabs, ice chips, and lip balm is crucial for relieving dry mucosa. Encourage small, frequent sips of preferred liquids if the patient is able to swallow safely.
• Subcutaneous Hydration (Hypodermoclysis): For persistent thirst unresponsive to oral care, low-volume subcutaneous hydration (500–1000 mL over 24 hours) can provide relief without the risks of fluid overload associated with IV fluids.

4. Monitoring Efficacy and Safety

Structured, routine assessments are critical to guide timely dose adjustments and detect adverse effects before they become severe. This ensures that interventions are effective and safe.

5. Psychosocial and Spiritual Support Integration

Holistic comfort care extends beyond physical symptoms to address the emotional, existential, and spiritual distress that patients and their families often experience. An interdisciplinary approach is paramount.

• Chaplaincy and Spiritual Care: Specialists can conduct spiritual assessments to understand a patient’s beliefs and values, offering support through prayer, rituals, readings, or simply a compassionate presence.
• Social Work: Social workers are vital for facilitating family meetings, preparing loved ones for the dying process, and connecting them with resources. They can also coach families on how to participate in care through non-drug comfort techniques.
• Complementary Therapies: Services like music therapy, massage, and pet therapy can enhance relaxation, reduce anxiety, and provide moments of joy and connection.

6. Implementation and Quality Metrics

Delivering consistent, high-quality comfort care requires standardized protocols, clear communication, and a commitment to continuous improvement.

• Nurse-Led Symptom Rounds: Proactive, structured rounds to review symptom assessment scores ensure that symptoms are identified early and interventions are timely.
• Audit and Quality Metrics: Institutions should track key metrics to measure the quality of care, such as the frequency of symptom assessments, time to first intervention for a reported symptom, documentation completeness, and rates of iatrogenic complications like pressure injuries.
• Multidisciplinary Debriefs: Regular meetings involving pharmacy, nursing, spiritual care, and medical teams help refine protocols, address challenges, and ensure care remains aligned with patient and family goals.