Assessment of the use of the Edmonton Symptom Assessment Scale – Revised (ESAS-r) among hospitalised patients with limited life expectancy: A cross-sectional study
TL;DR
The Edmonton Symptom Assessment Scale – Revised (ESAS-r) is an effective tool for monitoring both physical and psychological symptoms in hospitalized palliative patients among patients with limited life expectancy and poor functional status.
Abstract
Background Palliative care aims to improve the quality of life for patients with advanced chronic diseases. Accurate symptom assessment, based on fully completed questionnaires, is essential for selecting appropriate treatments during the final stages, when patients experience severe distress. Objectives This study evaluates the use of the Edmonton Symptom Assessment Scale – Revised (ESAS-r) in hospitalized patients with limited life expectancy. Design This cross-sectional study included hospitalized patients with advanced chronic diseases and a life expectancy of less than six months, as determined by the healthcare team’s clinical judgment using the Surprise Question at admission. Methods The ESAS-r, a validated brief self-report tool, was used to assess nine core symptoms and one additional symptom: pain, tiredness (lack of energy), nausea, drowsiness, lack of appetite, shortness of breath, depression (feeling sad), anxiety (feeling nervous), overall well-being, and an optional symptom. If the patient’s condition permitted, the investigator administered the questionnaire verbally and recorded the responses. If not, the reason was documented, and patient data were collected. Results The ESAS-r effectively captured a multidimensional profile of patient suffering. Depression, impaired well-being, and tiredness were the most severe symptoms reported. However, 45% of patients (n = 47/104) with significantly lower Karnofsky Performance Scale (KPS) scores were unable to complete the study due to poor general condition. Patients who died within six months had significantly higher rates of cancer (p = 0.016) and more severe appetite loss (p = 0.010) than survivors. Conclusion The ESAS-r is an effective tool for monitoring both physical and psychological symptoms in hospitalized palliative patients. Among patients with limited life expectancy and poor functional status, nearly half may be unable to complete the questionnaire due to their condition.