Symptom & Comfort Tracker
Relevant source files
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The Symptom & Comfort Tracker is a core module of the Hospice Roadmap platform designed to provide actionable guidance for managing medical symptoms, caregiving tasks, and medications. Its primary purpose is to help caregivers, patients, and families identify real-world clinical situations and receive immediate, step-by-step instructions on how to maintain comfort during the hospice journey.
Sources: replit.md:27-31, attached_assets/Pasted-The-goal-of-the-application-is-to-give-caregivers-patie_1773692362618.txt:1-5
The system facilitates daily check-ins for critical symptoms such as pain, breathlessness, and agitation. This data is not only used for local trend analysis but is also injected into the Ragna AI Companion to provide deeply personalized, context-aware guidance based on the patient's actual clinical status.
Sources: replit.md:38-40, artifacts/mobile/context/SymptomContext.tsx:103-120
Architecture and Data Flow
The Symptom Tracker operates through a decentralized architecture where tracking occurs on the mobile client via SymptomContext, while clinical intelligence and response planning reside on the API server within the symptomModel.
Data Lifecycle
- Capture: Users enter symptom scores (0-10) and qualitative observations.
- Storage: Entries are persisted locally using
AsyncStorage(limited to 90 entries). - Synthesis: The system calculates 7-day trends and identifies clinical alerts (e.g., pain ≥ 7 for three consecutive days).
- Intelligence Integration: Recent summaries are sent to the AI server to ground conversational responses in real-time patient data.
Clinical Domain Coverage
The tracker provides specialized guidance across several major clinical domains. Each domain includes definitions of what the user may notice, comfort measures, and specific "Hard Stops" indicating when to call hospice or 911.
Primary Symptom Categories
| Symptom | Urgency | Key Interventions |
|---|---|---|
| Pain | Urgent | Scheduled opioids, breakthrough (PRN) doses, PAINAD assessment. |
| Breathlessness | Urgent | Upright positioning, fan directed at face, low-dose morphine. |
| Agitation | Urgent | Stimuli reduction, Haloperidol, checking for urinary retention. |
| Terminal Secretions | Moderate | Side-lying positioning, anticholinergics (atropine/glycopyrrolate). |
| Delirium | Urgent | Gentle orientation, safety precautions, checking for metabolic causes. |
Sources: artifacts/api-server/src/intelligence/hospice/symptomModel.ts:18-120, artifacts/api-server/src/routes/anthropic/systemPrompt.ts:318-350
Trend Analysis and Alerts
The system performs automated clinical reasoning on the last 7 days of data to provide the user with situational awareness.
Trend Logic
- Upward Trend: Identified if the average pain in the newer half of the 7-day window is ≥ 1.5 points higher than the older half.
- Escalation Alert: Triggered if pain scores are 7 or above for three consecutive check-ins.
- High Score Frequency: Tracks how many times a score of 7+ was recorded across the reporting period.
Sources: artifacts/mobile/context/SymptomContext.tsx:103-130, artifacts/api-server/src/routes/anthropic/systemPrompt.ts:333-345
Integration with Ragna AI
The Ragna AI engine utilizes the symptom data to move beyond generic responses. When a user interacts with the chat, the system injects the "Recent Symptom Tracking" context into the prompt.
Medication Guidance Scope
The AI provides education on medications already prescribed in the user's "Comfort Kit." It identifies which medication addresses which symptom (e.g., Morphine for breathlessness) but is strictly prohibited from generating new dosing instructions or medical decisions that override the existing hospice care plan.
Sources: artifacts/api-server/src/routes/anthropic/systemPrompt.ts:401-415, artifacts/api-server/src/intelligence/hospice/catalog.ts:25-40
Documentation and Accountability
The module includes a "Documentation Coach" to help caregivers track symptom management effectively for clinical review or advocacy.
- Symptom Log: Encourages recording date, time, severity (0-10), medication given, and the patient's response.
- Call Log: Tracks communication with the hospice agency, including names of staff and promised actions, which serves as a record in case of care gaps.
Sources: artifacts/api-server/src/intelligence/hospice/documentationCoach.ts:12-45, artifacts/api-server/src/intelligence/hospice/catalog.ts:180-200
The Symptom & Comfort Tracker serves as a critical bridge between subjective caregiver observations and professional hospice interventions, ensuring that symptom distress is recognized and addressed with clinical precision even between nurse visits.