Divergent Perspectives on the Use of the Edmonton Symptom Assessment System (Revised) in Palliative Care

Abstract

The Edmonton Symptom Assessment System (Revised) (ESAS-r) contains 9 questions pertaining to symptoms/well-being. It is a standardized patient-reported assessment instrument, but inconsistently used in palliative care. Thus, a problem exists in knowledge translation regarding routine use of the ESAS-r in palliative practice. The objective was to understand clinicians' perspectives on the use of the ESAS-r in palliative care in hospitals and at home. Qualitative focus groups (n = 14 with 46 clinicians) and interviews (n = 24) elicited views regarding use of the ESAS-r in palliative practice. Interpretive description was used as a general approach to this qualitative analysis focused on understanding clinicians' views. Palliative clinicians presented multiple perspectives of the ESAS-r pertaining to their (1) underlying values, (2) disparate purposes, and (3) incommensurate responses toward use in daily practice. Benefits and challenges supported diversity within these themes, highlighting divergence among perspectives and complexity of integrating a standardized tool in patient care. Integration of the ESAS-r in palliative care requires (1) educational support for developing competence; (2) consideration of clinicians' existing, heterogeneous beliefs regarding the use of standardized assessment instruments; and (3) Consultation with multidisciplinary practitioners about optimal ways that ESAS-r results can be used in a person-centered approach to palliative care.

A narrative review of current evidence supporting the implementation of electronic patient-reported outcome measures in the management of chronic diseases

“… 51 , 70 , 72 – 75 Appropriate training of HCPs to handle and respond to ePROM data needs to be provided in order to facilitate integration with existing clinical workflows. 43 , 66 , 76 LeRouge et al have recently published a comprehensive toolkit to facilitate the process of implementation and integration of ePROMs with existing health systems. 77 This toolkit comprises of guidelines that focus on the various aspects of the process including ePROM integration approaches, workflow designing, leveraging of health ICT, and display of data.…”

“…11,[66][67][68] Concerns about workload; individual values, beliefs and priorities; lack of specific competence dealing with issues relating to emotional problems; PROM standardisation and quantification were noted as some of the determinants of HCP attitudes. 11,[66][67][68] A recent meta-synthesis by Easpiag et al showed an encouraging overall positive polarity of opinions among HCPs. 69 An awareness of the tensions and challenges experienced by HCPs with ePROMs and their engagement and involvement in ePROM system development, implementation and integration is essential to overcome these barriers.…”

“…51,70,[72][73][74][75] Appropriate training of HCPs to handle and respond to ePROM data needs to be provided in order to facilitate integration with existing clinical workflows. 43,66,76 LeRouge et al…”

“…11,66–68 Concerns about workload; individual values, beliefs and priorities; lack of specific competence dealing with issues relating to emotional problems; PROM standardisation and quantification were noted as some of the determinants of HCP attitudes. 11,66–68 A recent meta-synthesis by Easpiag et al showed an encouraging overall positive polarity of opinions among HCPs. 69…”

“…65 Scepticism among healthcare professionals A number of recent studies have explored indepth the practice tensions, scepticism and divergent views among healthcare professionals (HCPs) regarding the use of PROMs and ePROMs in clinical care. 11,[66][67][68] Concerns about workload; individual values, beliefs and priorities; lack of specific competence dealing with issues relating to emotional problems; PROM standardisation and quantification were noted as some of the determinants of HCP attitudes. 11,[66][67][68] A recent meta-synthesis by Easpiag et al showed an encouraging overall positive polarity of opinions among HCPs.…”