Integrating Palliative Care Services in Ambulatory Oncology: An Application of the Edmonton Symptom Assessment System

Abstract

PurposeResearch in palliative care demonstrates improvements in overall survival, quality of life, symptom management, and reductions in the cost of care. Despite the American Society of Clinical Oncology recommendation for early concurrent palliative care in patients with advanced cancer and high symptom burden, integrating palliative services is challenging. Our aims were to quantitatively describe the palliative referral rates and symptom burden in a South Texas cancer center and establish a palliative referral system by implementing the Edmonton Symptom Assessment Scale (ESAS). MethodsAs part of our Plan-Do-Study-Act process, all staff received an educational overview of the ESAS tool and consultation ordering process. The ESAS form was then implemented across five ambulatory oncology clinics to assess symptom burden and changes therein longitudinally. Referral rates and symptom assessment scores were tracked as metrics for quality improvement.

Piloting A Self-Reported Symptom Assessment Tool In Three Outpatient Oncology Palliative Care Clinics

“…The single QoL question has been validated and was found to be comparable to multi-item questionnaires [16]. It has been used extensively in the PC population with cancer [14,[17][18][19][20][21][22][23]. Based on extant literature and our communication with the PC team, there was mutual agreement that the ESAS-r with the global QoL question (ESAS-r + 1QoL) would be used for the assessment.…”

Symptom Assessment and Early Access to Supportive and Palliative Care for Patients With Advanced Solid Tumors in Mexico

“…The rate of referrals to palliative care has been reported to improve considerably after the implementation of systematic evaluation with simple tools such as the Edmonton Symptom Assessment Tool. 17 This strategy may be useful in settings where palliative care services are limited and may lead to an optimization in the selection of symptomatic patients.…”

“…The rate of referrals to subspecialty palliative care in cancer centers in the United States ranges from 8.5% to 46%. 17,18 Additionally, the utilization of other supportive care services among patients with advanced cancer varies according to the studied service, with reported referral rates of 15.1% to physical therapy, 25% to nutrition, and 29.7% to psychiatric/psychological counseling. 16 However, the World Health Organization estimates that only about 14% of patients in need of palliative care globally are able to access subspecialty palliative care.…”

The Role of a Symptom Assessment Tool in Shaping Patient-Physician Communication in Palliative Care

“…20 In addition to its clinical significance, the ESAS has also been used as a trigger for referrals to specialized palliative care services. 6,21,22 Recently, a study found that patient exposure to the ESAS (measured by completing the ESAS at least once) was associated with improved survival in cancer patients. 23 While numerous studies have assessed the validity, clinical significance, and usability 7,12,13,16 of the ESAS, fewer studies have examined the patient experience surrounding the ESAS.…”