Patient Symptom Assessment (ESAS-r) – Palliative Care

This online assessment helps us assess the severity of your symptoms as a palliative care patient. You may use the online form below to indicate how you are feeling by rating the severity of each symptom from 0 to 10. A 0 would mean that you have no symptom, and 10 would be the worst symptom ever. Of course, you can have a number anywhere in between.

The online assessment helps assess the severity of nine common symptoms  that are important to enhanced quality of life whether you are receiving cancer treatment or other treatments, for example dialysis. The assessment is called an ESAS-r, which stands for Edmonton Symptom Assessment System.

The ESAS assesses the severity over time of nine symptoms common among patients with cancer and other advanced illness: pain, tiredness, drowsiness, nausea, shortness of breath, appetite, depression, anxiety, and wellbeing.
This is one part of a holistic clinical assessment providing context for your symptom management. Assessment frequency will vary according to your symptoms.

How often should I fill out the assessment?

Please try to fill out the form daily, the day prior to your nurse's visit or if any change in condition. Try to do the assessment at approximately the same time each day or when you feel a change in your condition. If your symptoms are stable, you may only need to complete the form once a week.

What happens with the information I submit?

The home care coordinator will collect and monitor your responses which will provide valuable assistance for your ongoing care and symptom management.  

How will this help me?

Understanding and following your symptoms will allow your health care team to adjust your treatment more effectively to ensure you have the best quality of life possible as well as plan and react if your symptoms or you situation changes.

Who should complete the assessment?

The best assessment is the one done by you, the patient, indicating as accurately as possible the severity of symptoms at the time of assessment. However, it may be necessary for a caregiver or health care provider to assist you. If you are unable to do the assessment, then it may be completed on your behalf. The latter is not as accurate as one that comes directly from you.

For the best interpretation of results, it is important to identify who is completing the assessment each time. The form asks you to select from a list, i.e. patient, family caregiver, health care provider caregiver or caregiver assisted.

Note to caregiver: If you are completing the ESAS without patient assistance, please try to assess symptoms as objectively as possible, i.e. pain is on the basis of a knowledge of pain behaviours, appetite is interpreted as the absence or presence of eating, nausea as the absence or presence of retching or vomiting, and shortness of breath as laboured or accelerated respirations that appear to be causing distress for the patient.  Caregivers will not have the option to complete subjective symptoms, i.e. depression, anxiety and wellbeing.

What do I need to complete the assessment?

To access the symptom assessment on page two, you must enter the following patient information on page one:

• Personal identification and contact information
• Health care region
• Personal Health Number (PHN)

For the assessment, rate how you feel at the moment for each symptom, from 0 (no symptom) to 10 (worst possible).