Edmonton Symptom Assessment Scale Has Minimal Impact on Clinical Time

TON - January 2017, Vol 10, No 1 - Supportive Care
Chase Doyle

San Francisco, CA—Although patient self-reporting of symptoms has been shown to improve longitudinal tracking of symptoms and increase patient engagement in their care, these assessment tools are often underutilized in clinical care because they are thought to be time-consuming. Results from a new study, however, may finally put this perception to rest.

Researchers from The University of Texas M.D. Anderson Cancer Center have shown that the Edmonton Symptom Assessment Scale (ESAS) can be completed in less than 2 minutes with or without assistance by a healthcare professional. In addition, when nurse review time was included, no difference in time of completion was observed compared with assisted completion.

In an interview with The Oncology Nurse-APN/PA, lead investigator Angelique Wong, MD, Assistant Professor of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas M.D. Anderson Cancer Center, called the results “eye opening” and said that widespread use of ESAS will lead to better assessment of patients’ symptoms.

“Our results support that regular clinical use of ESAS will have minimal impact on clinical time. We know that symptoms affect patients’ quality of life and can affect their treatment, so my hope is that more clinicians will take advantage of this tool because it takes very little time,” said Dr Wong.

As Dr Wong reported at the recent Palliative Care in Oncology Symposium, ESAS is a multidimensional assessment tool for self-reporting of symptom intensity. Typically completed before a visit with a physician or nurse in the clinic or outpatient center, ESAS encourages patients’ involvement in their care while enhancing symptom tracking over time.

“When you see pain greatly increased at their 1-month follow-up, you can hone in on that during the visit, whereas if there was a big change in depression and anxiety, you can focus on that. Maybe they received bad news from their primary team or they were shown to have progression on their scans. [ESAS] is a great starting place for patients and helps clinicians guide the clinical encounter, as well,” explained Dr Wong.

ESAS Takes Less Than 2 Minutes

For this study, Dr Wong and colleagues randomized 127 patients (median age, 60 years) with advanced cancer who had never completed the ESAS to self-completion or assisted completion with a healthcare professional.

Before the administration of the ESAS, patients completed the Rapid Estimate of Adult Literacy in Medicine test. Time of completion was measured by a research assistant using a stopwatch.

In the self-completion group, the nurse reviewed responses to verify that the reported ESAS scores were correct, Dr Wong reported.

Following randomization, 58 patients completed the ESAS on their own, whereas 69 patients completed the self-report with assistance from a healthcare professional.

When researchers compared the time duration of groups, the median time of self-completion alone was significantly less than assisted completion (1.2 minutes vs 1.82 minutes). When nurse review time was included, the self-completion time increased to 1.92 minutes.

Completion of the ESAS was not only quick but also relatively easy, said Dr Wong, as the majority (58%) of patients reported they did not mind completing the ESAS alone or with the help of the nurse.

Patients with lower literacy scores, however, took longer to complete the self-report. Lower Rapid Estimate of Adult Literacy in Medicine test scores were associated with increased completion time (P = .007), the researchers noted.

Other demographic and clinical variables were not significantly associated with completion time.

According to Dr Wong, more consistent use of the ESAS could increase patients’ engagement in their own care, which, in turn, could counteract clinicians’ tendency to underestimate their patients’ symptoms.

“If patients aren’t given a chance to have their voice known, then they won’t feel involved in their care. My hope is that we’ll be able to use this tool more frequently with the data that have been shown,” Dr Wong concluded.

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Last modified: February 2, 2017