Background: Patient-based symptom scores are the standard method for assessment in palliative
care. There has been limited research on the frequency of errors upon using this approach.
The Edmonton Symptom Assessment Scale (ESAS) is a reliable and valid assessment
tool routinely used for symptom intensity assessment in our cancer center.
Objective: To determine if patients were scoring the symptoms on the ESAS in the way it
was supposed to be scored.
Settings: The study was carried out at the outpatient palliative care center.
Design and subjects: Retrospective review of 60 consecutive patient charts was done where
the patient had initially scored the ESAS. The physician looked at this scoring on the ESAS
and went back to the patient to do the scoring again to see if the patient had scored it in the
way it was intended to be scored. The same physician did the assessment on all of the patients.
Outcome measures: Level of agreement (weighted κ) before versus after the physician visit;
Screening performance of patient completed ESAS for mild and moderate symptom intensity.
Results: Complete agreement ranged from 58% (sleep) to 82% (well-being); the weighted κ
ranged from 0.49 (drowsiness) to 0.78 (well-being). There was more agreement for symptoms
such as dyspnea, nausea, anxiety, and depression and less agreement for symptoms such as
lack of sleep and lack of appetite. The screening performance of the initial patient self assessment
showed less sensitivity for nausea, drowsiness if the intensity was mild and less
sensitivity for pain, nausea, anxiety, and drowsiness if the intensity was moderate.
Conclusions: Vigilance needs to be maintained about the ESAS scores done by the patients
particularly for symptoms of sleep, appetite, and pain. There is a likelihood of error if doctors
or nurses do not routinely check the way patients have completed the assessment form.
More research is needed to determine the best way to teach patients how to minimize errors
in self-reporting of symptoms.
