ABCD framework
Dignity-conserving care has been described within an ABCD framework: A for attitude, underscoring the importance of care provider perception and the extent to which this can provide the patient a sense of affirmation and continued worth; B for behavior, denotes the various mannerisms and approaches that convey respect and acknowledgment of the patient’s personhood; C for compassion, predicated on an awareness of the patient as a person; and D for dialogue, underscores the importance of conversations that are able to acknowledge issues of personhood. (See also Chapter 27, Dignity-Conserving Care—A New Model for Palliative Care.)

Activities of daily living (ADLs)
ADLs are self-care activities of dressing, bathing, transferring, ability to ambulate, eating, and continence. ADLs are more basic than IADLs (instrumental activities of daily living) that include shopping, housework, accounting, food preparation, and transportation.

Acute Physiology and Chronic Health Evaluation (APACHE) II or III
A classification system that measures the severity of disease for adult patients admitted to intensive care units. For more information, see the following article for the classification system: Barie PS, Hydo LJ, Fischer E. Comparison of APACHE II and III scoring systems for mortality prediction in critical surgical illness. Arch Surg. 1995;130(1):77-82. [PMID: 7802581]

Addiction
Compulsive physical or physiologic need for and use of a habit-forming substance characterized by its misuse for purposes other than the one for which it was prescribed and despite negative consequences. Addiction is distinguished from tolerance (the patient requires increasing dosage to achieve the same analgesic effect) and from dependence (the patient requires continued dosing to prevent well-defined physiologic symptoms on withdrawal). See also Pseudoaddiction.

Adjuvant
Agent used to enhance the action of the main treatment. In palliative care, term used to describe different drugs and classes of drugs that may enhance the effects of opioids or nonsteroidal anti-inflammatory drugs, or of palliative chemotherapeutic agents.

Advance care directives
Instructions that are meant to ensure that patients’ wishes concerning end-of-life care are respected and carried out, even when the patients are no longer able to speak for themselves.

Advance care planning
The process by which patients, together with their families and health care practitioners, consider their values and goals and articulate preferences for future care.

Advance directives
A synonym for advance care directives (ACDs), instructions that are meant to ensure that patients’ wishes concerning end-of-life care are respected and carried out, even when the patients are no longer able to speak for themselves.

AIDS-related opportunistic infections
Infections due to pathogenic microbial agents that have the “opportunity” to develop in patients with compromised immune systems. These agents usually do not cause disease in patients with intact immune systems.

Alzheimer disease
A degenerative brain disease of unknown cause that results in progressive memory loss, impaired thinking, disorientation, and changes in personality and mood and that leads to a profound decline in cognitive and physical functioning. The most common form of dementia.

American Joint Committee on Cancer classifications
The American Joint Committee on Cancer classifications are used by medical professionals to select the most effective treatment, determine prognosis, and continue evaluating cancer control measures. The classifications involve clinical staging, pathologic staging, restaging, and the tumor-node-metastasis (TNM) staging system. For more information, see the following Web site for the classifications: http://www.cancerstaging.org. See also UICC-TNM.

American Spinal Injury Association Impairment Scale
The extent of spinal injury, defined by the American Spinal Injury Association Impairment Scale (modified from the Frankel classification), is categorized as follows: A-Complete: no sensory or motor function is preserved in sacral segments S4-S5; B-Incomplete: sensory, but not motor, function is preserved below the neurologic level and extends through sacral segments S4-S5; C-Incomplete: motor function is preserved below the neurologic level, and most key muscles below the neurologic level have muscle strength grade less than 3; D-Incomplete: motor function is preserved below the neurologic level, and most key muscles below the neurologic level have muscle grade greater than or equal to 3; and E-Normal: sensory and motor functions are normal. For more information, see the following Web site for the scale: http://www.asia-spinalinjury.org/publications/2006_Classif_worksheet.pdf.

Amyotrophic lateral sclerosis
A progressive neurodegenerative disorder of unknown cause and pathogenesis, with no known cure. It is characterized by progressive loss of motor neurons.

Analgesics, opioid
Medications that help to decrease perception of pain, decrease reaction to pain, and increase tolerance to pain.

Apnea test
The last clinical test performed during the examination for brain death. A positive test result requires discontinuation of mechanical ventilation and observation for the absence of any respiratory effort in the presence of an adequate stimulus for respiratory drive.

Autonomic dysfunction
Any disease or malfunction of the autonomic nervous system, producing symptoms such as orthostatic hypotension and gastroparesis.