The Edmonton symptom assessment system—what do patients think?

Abstract

Modification of the tool and administration process may be warranted, but further study in other populations is needed.

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

“…Some participants, however, lacked sufficient knowledge in the interpretation of certain symptoms, particularly tiredness, drowsiness, shortness of breath, well-being, and appetite. Reported benefits of the tool mainly related to direct patient care (symptom monitoring, treatment planning, communication); however, the tool was also useful for administrative and These findings suggest that the interpretation of symptoms is potentially problematic, not only for patients, as previously reported in the literature [9,20,21,23,24], but also for HCPs. Study participants provided many valid descriptions for explaining symptoms to patients, illustrating the complex multidimensional nature of most symptoms [22].…”

“…Study participants provided many valid descriptions for explaining symptoms to patients, illustrating the complex multidimensional nature of most symptoms [22]. However, similar to patients' experiences [20], some participants appeared to have more difficulty differentiating between potentially confusing terms, such as tiredness and drowsiness. Although shortness of breath was well understood as a subjective symptom by most participants, about one in five participants interpreted it as a combination of subjective symptoms and objective signs.…”

“…To address some of the issues associated with the tool itself, our research group has undertaken a series of studies to review the current status of the ESAS, identify problematic areas associated with its use in clinical practice and develop a revised version, the ESAS-r [12,14,20,31]. This revised version was based on a patient "think aloud" study, in which 20 patients were asked to provide their clinical reasoning regarding the ratings they selected while completing the ESAS, as well as their personal opinions regarding the tool [20]. A comparison study of the original ESAS and the ESAS-r, involving 160 patients, provided additional support for the proposed changes [31].…”

“…To develop the questionnaire, we reviewed the literature and obtained feedback from HCPs in the EZPCP to identify reported challenges with using the ESAS. We also considered concerns that were identified by patients in a think aloud study of the ESAS, in which they reported difficulties in interpretation of six of the nine symptoms [20]. The survey consisted of five sections: To assess HCP knowledge of the ESAS (Part 3), we examined the following three areas, which had previously been identified as problematic by patients [9,20]:…”

“…Additionally, numerous studies have demonstrated the lack of agreement between HCP assessment of symptoms and patient self-report [13,[16][17][18][19]. In one study, patients indicated that the presence of HCPs would help to clarify uncertainties and could contribute to accuracy and efficiency of the ESAS [20]. However, it is uncertain as to whether the patients difficulty understanding the ESAS and its correct usage extends to the HCPs themselves.…”