Edmonton Symptom Assessment Scale (ESAS): Time duration of self-completion versus assisted-completion in palliative care patients—A randomized controlled trial.

Abstract

67 Background: ESAS is a multidimensional assessment tool for self-reporting of symptom intensity. Unfortunately, ESAS is not used often in clinical care due to the perception that it may be time consuming. Our aim was to compare the time duration of self-completion (SC) of ESAS for the first time by patients with advanced cancer vs. assisted-completion (AC) with a health care professional (HCP). Methods: In this randomized controlled trial, patients with advanced cancer who have never completed the ESAS at MD Anderson were allocated (1:1) with a web-based system to either to self-completion of the ESAS form vs assisted completion by the research assistant. Time of completion was measured by the research assistant using a stop watch. Patients completed the Rapid Estimate of Adult Literacy in Medicine (REALM) test prior to administration of the ESAS. In the self-completion group, the nurse reviewed the responses to verify that the reported ESAS scores were correct (nurse review). Results: 127 patients were enrolled (69 patients to AC and 58 to SC). The median age was 60 years old, and median REALM score was 65. The median (IQR) time of SC alone was significantly less than AC (1.2 minutes (.7, 1.5) vs 1.82 minutes (1.3, 2.3), p = .000). With nurse review time included, the SC time increased to 1.92 minutes (p (vs. AC) = .28). Lower literacy (REALM) score was significantly associated with increased completion time (p = .007). Other demographical and clinical variables were not significantly associated with completion time. 73/127 (58%) patients reported they did not mind completing the ESAS alone or with the help of the nurse. Conclusions: The ESAS can be completed in less than 2 minutes with or without assistance by a HCP. When nurse review time was included, there was no difference in time of completion as compared to assisted completion. Our results support that regular clinical use of ESAS will have minimal impact on clinical time.