The Edmonton symptom assessment system--what do patients think?

Area of Science:

• Palliative Care
• Symptom Management
• Psychometrics

Background:

• The Edmonton Symptom Assessment System (ESAS) is widely used in palliative care for advanced cancer patients.
• Few studies have examined the psychometric properties of ESAS, and none have incorporated patient perspectives.
• Understanding patient cognitive processes is crucial for validating self-reporting tools.

Purpose of the Study:

• To gather validity evidence for the ESAS by examining patient cognitive processes.
• To assess patient understanding of ESAS terminology and numerical ratings.
• To evaluate patient opinions on the ESAS as a self-reporting tool.

Main Methods:

• A qualitative 'think aloud' study design was employed with English-speaking advanced cancer patients.
• Patients completed the ESAS independently while verbalizing their thoughts.
• A structured questionnaire was used to gather patient opinions on the ESAS.

Main Results:

• Symptom ratings were influenced by current status, history, and individual perceptions.
• Patients experienced difficulties with terminology such as 'tiredness,' 'drowsiness,' 'depression,' 'anxiety,' 'appetite,' and 'well-being.'
• Patients found the ESAS easy to complete with a healthcare professional present and suggested emphasizing the timeframe as 'now'.

Conclusions:

• Modifications to the ESAS tool and its administration process may be beneficial.
• Further research is needed to validate the ESAS in diverse patient populations.
• Incorporating patient feedback is essential for refining symptom assessment tools.