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The symptoms of 86 patients referred to a district terminal care support team were rated throughout care using a standardized schedule. Pain was the most common main symptom at referral, occurring in 35 (41%) of the patients. The assessment scores for pain showed significant improvements after one week of care (P less than 0.01) and there was a further improvement into the week of death. However, towards death, 18 (21%) patients developed dyspnoea as their main symptom, and this became the most severe symptom at death. The symptom assessment scores for patients with dyspnoea showed no change over time, suggesting that existing methods to control dyspnoea are ineffective and that new interventions are needed.