Monitoring Symptoms in Patients with Advanced Illness in Long-Term Care: A Pilot Study

Abstract

The Edmonton Symptom Assessment Scale (ESAS) was administered daily by nursing staff in a long-term care facility (LTCF) to monitor symptoms. Scores greater than or equal to 5 on a 0-10 scale were considered moderate-to-severe and triggered prompt treatment. One hundred and eight patients with advanced illness and perceived prognosis of less than 6 months were identified for rapid symptom management over a 7-month period. Forty-six (43%) of these patients had at least one episode of moderate-to-severe symptoms during the follow-up period. Thirty-one of these patients (67%) had a primary diagnosis of advanced AIDS and 12 (26%) had advanced cancer. Pain was the most frequent of the 15 symptoms measured, occurring in 29 patients. In the case of pain (P = 0.001), tiredness (P = 0.004), and well-being (P = 0.003), rapid symptom management led to significantly improved distress scores within 48 hours. These data suggest that it is feasible for nurses in an LTCF to use the ESAS on a daily basis to assess patients and obtain prompt treatment for distressful symptoms. Rapid treatment of symptoms can be an important quality indicator in nursing home patients with advanced illness.

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

“…More than 130 relevant articles and abstracts were identified, of which thirty-nine were primary studies published as complete peer-reviewed papers, representing 25 different institutions. Of the thirty-nine papers, thirteen were from Canada 6,11,[20][21][22][23][24][25][26][27][28][29][30] ; eight were from the United States [12][13][14]18,[31][32][33][34] ; eight were from Scandinavia (Sweden 15,[35][36][37] , Denmark [38][39] , Norway 40 , Finland 16 ); two were from Western Europe (Netherlands 41 , United Kingdom 42 ); five were from southern Europe (Switzerland 43 , Italy 17,[44][45][46] ); two were from Australia 47,48 ; and one was from Asia 49 .…”

Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team

“…Demographic data (ie, patient age and sex) and clinical data (ie, type of cancer and reasons for ICU admission) were collected. Symptom profile data from the day of the initial consultation were collected and assessed using the Edmonton Symptom Assessment Scale (ESAS), [16][17][18][19] which is a series of visual analogue scales that rate pain, fatigue, nausea, depression, anxiety, drowsiness, sleep, appetite, well being, and shortness of breath. The ESAS was completed by each patient independently unless the patient was unable to rate all the symptoms; in such cases, a physician or nurse assisted the patient.…”

“…Only 22 patients (25%) were able to complete both the baseline and follow-up ESAS. For the patients who did complete the ESAS, significant improvements were documented in pain ( Delirium improved in 21 patients (30%) who were able to complete the MDAS from an initial median score of 13 (range, 8-21) to a median MDAS score of 11 (range, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Of these 21 patients, 20 (95%) were discharged alive (9 patients were discharged to home with hospice services, 5 patients were discharged to an inpatient hospice unit, 4 patients were discharged to home with outpatient follow-up, and 2 patients were discharged to a skilled nursing facility).…”

Physical problems and needs of patients in palliative care center

“…As a sensory experience, pain is moderate to severe in intensity among patients receiving palliative care or those at the end of life. [9][10][11][12][13][14] Pain is commonly reported as possessing complex qualities and variable in its pattern often in more than one location. 15 It is also associated with an affective dimension that includes distress and suffering.…”