Aug 25, 2012 - Background: Many symptom assessment tools have been developed to aid evaluation of patient's symptoms. ..
ISSN: 2165-7386
Journal of Palliative Care & Medicine The International Open Access Journal of Palliative Care & Medicine
Executive Editors David M Steinhorn Northwestern University, USA Scott A Murray University of Edinburgh, UK Peter C Coyte University of Toronto, Canada Margaret O’Connor Monash University, Australia Anne Wilkinson Edith Cowan University, Western Australia
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his article was originally published in a journal by OMICS Publishing Group, and the attached copy is provided by OMICS Publishing Group for the author’s benefit and for the benefit of the author’s institution, for commercial/research/educational use including without limitation use in instruction at your institution, sending it to specific colleagues that you know, and providing a copy to your institution’s administrator. All other uses, reproduction and distribution, including without limitation commercial reprints, selling or licensing copies or access, or posting on open internet sites, your personal or institution’s website or repository, are requested to cite properly. Digital Object Identifier: http://dx.doi.org/10.4172/2165-7386.1000128
Lucey et al., J Palliative Care Med 2012, 2:7 http://dx.doi.org/10.4172/2165-7386.1000128
Palliative Care & Medicine Research Article
Open Access
Exploring the Challenges of Implementing the Edmonton Symptom Assessment Scale in a Specialist Palliative Care Unit M Lucey1*, M Conroy2 and K Ryan3 Consultant in Palliative Medicine in Milford Hospice, Limerick, Ireland Consultant in Palliative Medicine in Milford Hospice, Limerick, Ireland 3 Consultant in Palliative Medicine, St Francis Hospice, Raheny, Ireland 1 2
Abstract Background: Many symptom assessment tools have been developed to aid evaluation of patient’s symptoms. The Edmonton Symptom Assessment Scale is one such tool. The ESAS was introduced on the inpatient unit in Milford Hospice (a 30 bedded tertiary palliative care unit) in December 2007. However, a 3-month chart review revealed a low completion rate (20%) of the ESAS. Aim: The aim of this study was to assess the reasons for the low completion rate of the ESAS in the unit. Methods: A mixed methods approach using both questionnaire and focus group was undertaken. The population sampled was the nursing staff who were responsible for ensuring the completion of the ESAS in the unit on a daily basis. Results: The main reason for the low completion rate of the ESAS was that nursing staff perceived that it was too burdensome for sick patients to complete (76%). Also, nursing staff felt that the tool was not clinically helpful and that it was too time consuming for patients to regularly complete. Other important issues relating to the introduction process for symptom assessment tools are also identified. Conclusions: The results of this study are consistent with findings in the literature relating to other symptom assessment tools. Implementing such tools may be burdensome for patients with a poor functional status in an advanced cancer setting. Areas of focus for further research include shorter symptom assessment tools which are more reflective of a patients twenty four hour symptom profile, and also proxy rated assessment tools.
Keywords: Edmonton symptom assessment scale; Palliative care unit; Nursing perceptions; Patient burden
Introduction Many patients admitted to specialist palliative care units have troublesome and challenging symptoms. In patients with advancing cancer, symptom burden worsens with cancer stage [1] and this symptom distress decreases quality of life [2]. Many symptom assessment tools have been developed to assist with symptom evaluation and measurement. In one study looking at the number of symptom assessment tools available, 21 symptom assessment tools were identified with another 28 in existence examining symptom prevalence and interrelations [3]. One such symptom assessment tool, the Edmonton symptom assessment scale or ESAS, has received much attention in recent times. Developed by Bruera et al in 1991 it is an 11 point numerical rating scale used to rate 9 symptoms with an optional 10th symptom nominated by the patient. The presence and severity of each symptom is scored from 0 to 10. The scoring process can be completed by the patient alone or with the help of a caregiver. If the patient is unable to complete the exercise the care-giver can do so on their behalf [4,5]. In December 2007 the ESAS was introduced as a quality indicator of symptom control in the specialist palliative care unit of Milford Hospice.This is a thirty-bedded specialist palliative care unit in Limerick, Ireland, where most patients admitted have advanced cancer (>90%) and where 10% have non-malignant disease (Table 1). The introduction of the ESAS was reflective of a more general quality assurance drive within the hospice which was part of an organisational accreditation process.
Introduction of the ESAS Staff were educated in the use of the ESAS. The researcher held 2 educational sessions each for nursing staff, management and nonJ Palliative Care Med ISSN: 2165-7386 JPCM, an open access journal
consultant hospital doctors. A further 2 sessions were held for the multidisciplinary team (a total of eight sessions). It was explained that the 11 point horizontal numerical scale ESAS was to be completed by the patient with the admitting doctor on admission and thereafter by nursing staff once daily.
Assessment of nursing perceptions of the ESAS After a three-month period, a chart review (40 charts) was undertaken with a view to assessing the completion rate of the ESAS. This revealed only a 20% successful completion of the ESAS on the wards. To investigate the cause of this low completion rate, a study was undertaken to assess nursing staff perceptions of the ESAS.
Methods Ethical approval Ethical approval for this study was obtained from the Midwestern Regional Hospital Ethics Committee in Limerick, Ireland. A mixed methods approach was undertaken using both a questionnaire and a focus group to assess the nursing staff perceptions of the ESAS. The sample was drawn from nursing staff who were working in the hospice during the introduction of the ESAS.
*Corresponding author: Dr. Michael Lucey, Consultant in Palliative Medicine, Milford Hospice, Castletroy, Limerick, Ireland, Tel: +353868582026; E-mail:
[email protected] Received June 27, 2012; Accepted August 23, 2012; Published August 25, 2012 Citation: Lucey M, Conroy M, Ryan K (2012) Exploring the Challenges of Implementing the Edmonton Symptom Assessment Scale in a Specialist Palliative Care Unit. J Palliative Care Med 2:128. doi:10.4172/2165-7386.1000128 Copyright: © 2012 Lucey M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Volume 2 • Issue 7 • 1000128
Citation: Lucey M, Conroy M, Ryan K (2012) Exploring the Challenges of Implementing the Edmonton Symptom Assessment Scale in a Specialist Palliative Care Unit. J Palliative Care Med 2:128. doi:10.4172/2165-7386.1000128 Page 2 of 5 Number of admissions
83
Number of readmissions
46
Total number of admissions
129
Average length of stay
12 days
Patient outcomes
54% discharged/ 46% Deaths
Types of disease
Breast/ lung/ Colonic / Prostate cancer (>90%) Non malignant Disease (
