Do high symptom scores trigger clinical actions by providers? Assessing the effect of standardized symptom screening.

Abstract

9127 Background: Standardized cancer symptom screening is being used increasingly in cancer care systems. It is assumed that by using a standardized approach to symptom screening, the quality of care will be improved. Since 2007, Ontario cancer centres have implemented an electronic version of the Edmonton Symptom Assessment Scale (ESAS) at every patient visit. To date, there is little research documenting the relationship between screening and resultant clinical actions. This study examines how ESAS scores are associated with rates of symptom documentation in the patient chart and clinical actions taken. Methods: Retrospective chart reviews on a random stratified sample of visits by ambulatory lung and breast cancer patients at a large regional cancer centre. The dependent variable was ESAS symptom scores for pain and shortness of breath, categorized by severity: 0=none, 1-3, 4-6, and 7-10=severe. Outcomes included symptom documentation in the chart on the visit date and symptom-related action(s) taken within a week. Chart reviewers were blinded to ESAS scores. Results: 912 unique visits were reviewed, 25% from each score category. Pain and shortness of breath were documented in 51.8% and 29.7% of charts and a related action occurred in 16.9% and 3.9% of charts respectively. The proportion of visits that had pain documented increased significantly (36.9%, 49.2%, 55.2%, and 71.4%; p<0.001) as ESAS score category increased. Likewise, from low to high ESAS score category, the proportion of visits that had a pain-related action increased significantly (4.2%, 10.6%, 21.3%, and 37.0%; p<0.001). Similar trends were found for shortness of breath but at much lower rates with overall only 11.1% having evidence of actions taken when the symptom was documented in the chart. Conclusions: Our results illustrate the link between standardized symptom screening and clinical actions. However, substantial opportunities for improvement remain as symptom-related actions were documented infrequently, even when symptoms were reported as severe. Future research that addresses this apparant gap between screening and actions is important to support the concept of routine screening to improve quality of care.