Edmonton Symptom Assessment System ESAS
Edmonton Symptom Assessment System ESAS overview
Creator and Context
The Edmonton Symptom Assessment System (ESAS) is a nine symptom self report measure developed for palliative care.
It was created by Eduardo Bruera and colleagues in 1991 and revised as the ESAS-r by Sharon Watanabe, Cheryl Nekolaichuk and colleagues in 2011. The revision fixed known comprehension problems in the original wording.
It is freely available with acknowledgement of its source, but may not be modified without the authors' consent.
Presenting Conditions
The ESAS-r covers nine symptoms, plus one blank line for another symptom:
Pain
Tiredness
Drowsiness
Nausea
Lack of appetite
Shortness of breath
Depression
Anxiety
Wellbeing
Administration
Self completed by the patient in two to five minutes, and can be completed with nurse or carer assistance where the person cannot self report. Each symptom is rated 0 to 10, where 0 is absence and 10 is the worst possible severity.
The recall window is now, at this point in time.
Desired Audience
Palliative care and advanced cancer patients, and now widely used in oncology, nephrology and other settings with serious illness.
Where physical and psychological symptoms are tangled together, and in palliative care they always are, a single instrument that records both on the same scale is worth more than two separate ones. Depression and anxiety sit alongside pain and breathlessness, which is exactly how the patient experiences them.
Considerations
It is a screening tool and must sit inside a fuller clinical assessment.
At least eight different English variants of the ESAS circulate, with different item counts, anchors and time frames. Cross study comparison is unsafe. Standardise on the ESAS-r.
The original wording caused patient confusion between tiredness and drowsiness, and reverse scoring errors on wellbeing and appetite. The ESAS-r fixes these. Do not reintroduce the old wording.
The total symptom distress score is a researcher derived construct, not part of the original design.
The instrument may not be modified without the authors' consent.
How to score the Edmonton Symptom Assessment System ESAS
Conducting the assessment
The person rates each of the nine symptoms from 0 to 10 for how they feel now, and may add one further symptom.
Interpretation
Each symptom is scored 0 to 10 and read individually.
Widely used severity bands: 0 is none, 1 to 3 mild, 4 to 6 moderate and 7 to 10 severe.
The evidence base (Selby et al., 2010) found that 7 was the optimal cut point for severe pain, depression, anxiety, drowsiness, appetite and wellbeing, 8 for severe fatigue and 6 for breathlessness. A cut point of 4 or 5 reasonably defines moderate and above.
Clinical Considerations
Read the symptoms individually. Totalling them hides the one that is actually distressing the person.
Act on the depression and anxiety items. In palliative settings they are routinely under treated because they are assumed to be an understandable reaction.
Track the graph over time. A rising trend matters more than a single reading.
Edmonton Symptom Assessment System ESAS use cases
Symptom screening in palliative and supportive care
Tracking symptom burden over time using the ESAS-r graph
Capturing psychological and physical symptoms on a single instrument
Research in palliative and oncology care
Category
General Well-being
Research Summary
Bruera, E., Kuehn, N., Miller, M. J., Selmser, P., & Macmillan, K. (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care, 7(2), 6 to 9.
Watanabe, S. M., Nekolaichuk, C., Beaumont, C., Johnson, L., Myers, J., & Strasser, F. (2011). A multicenter study comparing two numerical versions of the Edmonton Symptom Assessment System in palliative care patients. Journal of Pain and Symptom Management, 41(2), 456 to 468.
Hui, D., & Bruera, E. (2017). The Edmonton Symptom Assessment System 25 years later: Past, present, and future developments. Journal of Pain and Symptom Management, 53(3), 630 to 643.
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