Palliative Care Providers' Opinions of the Edmonton Symptom Assessment System Revised (ESAS-r) in Clinical Practice

Abstract

The Edmonton Symptom Assessment System (ESAS) is a widely used, self-report, symptom intensity tool for assessing nine common symptoms in palliative care; ratings range from 0 (none, best) to 10 (worst).1Bruera E. Kuehn N. Miller M.J. Selmser P. Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients.J Palliat Care. 1991; 7: 6-9PubMed Google Scholar, 2Cummings G. Biondo P. Hagen N. Fainsinger R. Stiles C. Bibilometric review: Edmonton Symptom Assessment Scale (ESAS).Palliat Med. 2008; 22: 552-553Google Scholar The ESAS-Revised (ESAS-r), a revision of the ESAS, provides definitions for potentially confusing items (tiredness, drowsiness, depression, anxiety, and well-being), specifies the time frame as “now,” and reorders symptoms into physical first and psychosocial-spiritual second, with well-being last; also, the example of constipation is given for “other symptom.” A multicenter study conducted with palliative care patients showed that the ESAS-r was significantly easier to understand than, and preferred to, the ESAS.3Edmonton Symptom Assessment System (revised version)(ESAS-r). Available from http://www.palliative.org/PC/ClinicalInfo/AssessmentTools/3C7%20ESAS-r.pdf. Accessed on July 20, 2012.Google Scholar The ESAS-r replaced the ESAS throughout the Edmonton Zone Palliative Care Program (EZPCP) in January 2011.4Guidelines for using the revised Edmonton Symptom Assessment System (ESAS-r). Available from http://www.palliative.org/PC/ClinicalInfo/AssessmentTools/3C7%20ESAS-r%20guidelines.pdf. Accessed on July 20, 2012.Google Scholar Guidelines for using the ESAS-r also were developed.5Watanabe S.M. Nekolaichuk C. Beaumont C. et al.A multicenter validation study of two numerical versions of the Edmonton Symptom Assessment System in palliative care patients.J Pain Symptom Manage. 2011; 41: 456-468Abstract Full Text Full Text PDF PubMed Scopus (226) Google Scholar We undertook a study with the aim of obtaining palliative care providers' opinions of the ESAS-r in clinical practice. In the fall of 2011, a survey was distributed to all EZPCP staff. The survey included 11 items rated on a five-point Likert scale (1 = strongly disagree, 5 = strongly agree), and five free-text items. Information was collected on professional discipline, work setting, and years of practice in palliative care. Rates of agreement were compared between disciplines and work settings using Pearson's Chi-square test. Approval was obtained from the local research ethics board. Two hundred and eleven surveys were distributed in electronic or paper format. Eighty were returned, for a response rate of 39.3%. Professional disciplines represented were registered nurses (56.6%), licensed practical nurses (LPNs) (14.5%), nursing attendants (NAs) (12.0%), physicians (9.6%), and other or missing (7.2%). Work settings comprised the tertiary palliative care unit (26.5%), hospices (25.3%), acute care hospital/cancer center/community consultation services (21.7%), home care (15.7%), and other or missing (10.8%). Median years working in palliative care was 7.8 (range 1-26). Overall rates of agreement (agree/strongly agree) for the entire sample ranged from 77.5% for clarification of the time frame as “now,” to 96.3% for the definition for tiredness (Table 1). There were no statistically significant differences in rates of agreement between disciplines or work settings, except that LPNs and NAs had a lower rate of agreement for the item regarding the helpfulness of the guidelines. Analysis was limited by the small numbers in each subgroup.Table 1Rates of Agreement With ESAS-r Revisions and Corresponding Survey Questions (Total N = 83)Survey Questionsn (%)aDenominator varies because of missing responses.Tiredness definition77 (96.3)Drowsiness definition71 (88.8)Depression definition70 (88.6)Anxiety definition68 (85.0)Well-being definition67 (84.8)Clarification of the time frame as “now”62 (77.5)Reordering symptoms by physical components then psychosocial-spiritual components69 (87.3)Reordering well-being to the end of the symptoms65 (83.3)Inclusion of an example (i.e., constipation)64 (81.0)ESAS-r being adopted for use in clinical practice76 (93.8)Guidelines are helpful73 (90.1)a Denominator varies because of missing responses. Open table in a new tab In the free-text items, the most frequently cited strength of the ESAS-r was that it is easier to complete or clearer than the ESAS (n = 20). Multiple suggestions for improvement were made, with the most common being a need to clarify the “lack of appetite” descriptor (n = 5) and making the tool easier for particular groups of patients to use, for example, those with a lower level of schooling (n = 5). Although the response rate was moderately low, palliative care providers who responded to the survey had highly favorable opinions of the ESAS-r as a tool for clinical practice. Further work is needed on a number of aspects of the instrument, including time frame, terminology (particularly appetite), and usability for specific populations. This work was funded by a grant from Covenant Health. A Multicenter Study Comparing Two Numerical Versions of the Edmonton Symptom Assessment System in Palliative Care PatientsJournal of Pain and Symptom ManagementVol. 41Issue 2PreviewThe Edmonton Symptom Assessment System (ESAS) is a widely used, self-report symptom intensity tool for assessing nine common symptoms in palliative care, with ratings ranging from 0 (none, best) to 10 (worst). Based on a “think-aloud” study of 20 advanced cancer patients, the ESAS was revised (ESAS-r). Full-Text PDF Open Access