The use of the Edmonton Symptom Assessment Scale (ESAS) within a palliative care unit in the UK

Abstract

The Edmonton Symptom Assessment scale (ESAS) was used on 1004 occasions to assess 71 patients with advanced malignant disease admitted to a palliative care unit in the UK over a six-week period. The median length of inpatient stay was eight days (range 1-36) and the median survival from start of ESAS to death was 16 days (range 2-202). Across all patients there was a trend towards worsening symptom scores over the first five days from admission with a significant deterioration in appetite scores. When scores were analysed retrospectively over five days according to outcome (death--group 1, or discharge--group 2) there was a significant improvement in pain scores in group 2 but no change in overall score, and a significant deterioration in activity, drowsiness and appetite in group 1 with no change in overall score. ESAS did not seem an appropriate tool in this group of patients as the total symptom scores were so often biased by the inevitable increase in individual symptom scores immediately prior to death.

Impact of Combined Hospice Care on Terminal Cancer Patients

“…[34][35][36][37][38][39][40][41] According to two analyses of patients with terminal cancer in varied palliative care settings, fatigue was the most frequently reported symptom, and pain, depression, and anxiety were the most distressing symptoms. 2,42 In this study, the most frequently reported symptoms were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%).…”

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

“…Reliability by test-retest with the ESAS and within 1 day is generally high, exceeding 0.8 6,11,12,31,[42][43] , with the exception of one report of 0.35-0.72 21 . Collectively, studies have concluded that the ESAS need not be administered more than once daily for most palliative patients, even when in hospital.…”

“…Longitudinal scores can be found in fifteen papers 6,11,15,17,23,[25][26][27][28][29]33,40,42,45,46 . Given that some patients were admitted for great acuity of symptoms and for immediate care and benefit, and that others experienced very short survival times with increasing difficulties in completing the ESAS, such studies may be understood as tests of positive and negative responsiveness.…”

“…Most studies did not tally or measure interventions, and they provided no data for associations between interventions and changes in scores 6,11,13,15,17,31,42 . Heedman and Strang 36 showed no association between pain level and changes in pain medications, but others showed that some item scores responded to relevant interventions.…”

“…No comparisons of these versions of scales have been published, although some authors have claimed that visual analog and numeric scales elicit similar scoring 51 . Numeric scales may be more acceptable to patients, more efficient to score 31,42,48 , and applicable from bedside care to telephone follow-up 25 .…”