Multidisciplinary Health Care Professionals' Perceptions of the Use and Utility of a Symptom Assessment System for Oncology Patients

Abstract

Purpose: Despite growing implementation of electronic symptom assessment in oncology settings, few studies have described how standardized symptom assessment can enhance multidisciplinary care. The Edmonton Symptom Assessment System (ESAS) is a validated measure of symptom burden that has been adopted by Ontario's cancer centers to assess symptoms for patients with cancer. This study examines the perceived value of the ESAS among clinical teams and barriers to its use in enhancing multidisciplinary care.Methods: Self-completed surveys were administered online to clinical teams at various disease-site clinics at a cancer center in Ontario, Canada.

Health care providers’ use and knowledge of the Edmonton Symptom Assessment System (ESAS): is there a need to improve information and training?

“…In a pilot study implementing the ESAS in hospice settings, HCPs [15] valued the ESAS for its brevity, practicality for identifying patient care issues, engagement of patients in symptom assessment and use as a teaching tool. A second study revealed that use of the ESAS led to improvements in patient care [29]. The clinical relevancy of the ESAS is further supported by a recent review of clinical instruments for hospice and palliative care [30].…”

“…Some HCPs have suggested that the tool lacks clinical relevancy if other team members do not refer to the tool when deciding about treatment options [28]. Others have highlighted concerns regarding the lack of understanding regarding the tool's use, particularly with respect to frequency of assessments and the misinterpretation of numerical rating scales [15,29]. In one study [15], participants reported concerns about high symptom ratings being interpreted as poor quality of care.…”

“…Previously reported concerns from HCPs have focused on four key areas: (a) clinical relevancy [28], (b) misunderstandings regarding appropriate use [15,29], (c) misinterpretation of high symptom ratings as poor quality of care [15], and (d) attitudinal barriers [15,28]. Some HCPs have suggested that the tool lacks clinical relevancy if other team members do not refer to the tool when deciding about treatment options [28].…”

“…In some cases, patients may rate their symptoms high, yet also view this as being a preferred or acceptable level of symptom control [25]. Attitudinal issues included viewing routine assessments as "unnatural" or burdensome for patients [15,28], or preferences to use one's own symptom assessments [29]. These concerns reinforce the need for targeted knowledge translation activities and educational programs for staff to enhance the uptake and ensure the appropriate use of the ESAS in clinical practice [28].…”

“…Barriers to implementing the ESAS extend beyond the features of the tool, itself, to staff-related concerns [27][28][29].…”