A Review of the Reliability and Validity of the Edmonton Symptom Assessment System

Abstract

BackgroundSystematic symptom reporting by patients and the use of questionnaires such as the Edmonton Symptom Assessment System (ESAS) have potential to improve clinical encounters and patient satisfaction. We review findings from published studies of the ESAS to guide use of the system and to focus research. MethodsA systematic search for articles from 1991 through 2007 found thirty-nine peer-reviewed papers from 25 different institutions, thirty-three of which focused on patients with cancer. Observations, data, and statistics were collated according to relevance, reliability, validity, and responsiveness. ResultsFindings apply predominantly to symptomatic palliative patients with advanced cancer who were no longer receiving active oncologic therapies. Uncertainty about summarizing findings arises from frequent modification of the ESAS (altered items, scales, and time periods). Overall, reliability is established for daily administration. Scores are skewed, with a floor effect, but the relative order of symptoms by mean scores is similar across studies. Emotional symptoms are poorly captured by the depression and anxiety items. An equally weighted summation of scores may estimate a construct of "physical symptom distress," which in turn is related to performance status, palliative goals, quality of life, and well-being. ConclusionsThe ESAS is reliable, but it has restricted validity, and its use requires a sound clinical process to help interpret scores and to give them an appropriate level of attention. Research priorities are to further develop the ESAS for assessing a greater number of important physical symptoms (and to target "physical symptom

Palliative Care Gaps in Providing Psychological Treatment: A Review of the Current State of Research in Multidisciplinary Palliative Care

“…For example, the Edmonton Symptom Assessment Scale (ESAS), which was the most frequently utilized scale in the analyzed studies, has repeatedly been found to have only a modest or no association with the Hospital Anxiety and Depression Scale, and no valid cutoffs have been established for screening with the ESAS items on anxiety and depression. 25 The majority of studies did not include a specific psychological measure but did include general measures of quality of life or distress, which similarly fail to elucidate what aspects of life or distress improved as a result of the intervention. Mental health scales that have a robust evidence base for being able to validly and reliably assess psychological symptoms as well as changes in psychological symptoms were only used in 15 (25.4%) of the 59 studies.…”

A critical analysis of test-retest reliability in instrument validation studies of cancer patients under palliative care: a systematic review

“…Retested patients must be in a stable condition with respect to the construct to be measured by the PRO. This situation is particularly problematic in PC settings because advanced cancer patients are prone to a faster rate of clinical deterioration [ 4 ].…”

Screening Performance of Edmonton Symptom Assessment System in Kidney Transplant Recipients

“…Furthermore, ESAS seemed to "balance" physical and psychological domains, including DT, and to better capture the emotional symptom burden. Indeed, all ESAS versions have physical symptoms outnumber items which induced patients to perceive the focus to be more physical than psychological symptoms [23]. The KTRs' perception of emotional symptom burden is likely more important than any objective clinical parameters in determining the KTRs' quality of life because KTRs reported many stressors, namely fear of rejection, worries about the risk of infection and prior to clinic visits, repeated hospitalizations, socio-economic status, side effects of immunosuppressive therapy and changes in body appearance [54].…”

“…The urgency for standardized psychiatric and psychosocial screening for distress in KTRs is also supported by the high prevalence of alexithymia [20], defined as a difficulty in identifying and describing emotions. The most commonly used psychiatric screening tools are however time-consuming and difficult for patients to complete [21][22][23][24][25][26][27]. A pragmatic patient-centred symptom assessment tool with visual analogue scale, the Edmonton Symptom Assessment System (ESAS), has been validated in dialysis patients [28] and, recently, in a single kidney-transplant cohort [29][30][31].…”