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Healtht"ttsreJl
Qassim fluster

Policy Title usE oF EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS-R)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care qHc-Moc-PP-042-E-V1 New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
221O812022 2sl08l2O22 2210812024 11
Hospital

l STATEMENT OF PURPOSE
1.1 To provide guidelines for the use of the Edmonton Symptom Assessment System (ESAS-r). 1.2
To ensure that palliative care interventions are evaluated by a validated assessment tool.

2 DEF!NITIONS

2.1 Edmonton Symptom Assessment System (ESAS): a tool that was developed to assist in the
assessment of nine symptoms that are common in palliative care patients: pain, tiredness, drowsiness,
nausea, lack of appetite, depression, anxiety, shortness of breath, and wellbeing. lt is intended to
capture the patient's perspective of their symptoms, though in some situations a caregiver's
perspective may be needed, and repeated use can give an indication of symptom progression.

2.2 the revised version of the tool. Changes include specifying a timeframe of "now" , adding
ESAS-r: ls
definitions for potentially confusing symptoms, modifying the order of symptoms, adding an example
for "other symptom", and altering the format for improved readability.

2.3 PPS: Palliative Performance Scale. lt is a tool developed as an excellent communication toolfor
quickly describing a patient's current functional level. lt appears to have prognostic value. PPS scores
are determined by reading horizontally at each level to find a 'best fit' for the patient which is then
assigned as the PPS% score.

2.4 Palliative Home Care: palliative patients who are being cared for at home team.

2.5 Palliative Care lnpatients: all admitted patients who are under the care of the Palliative Care team

3 GENERAL GUIDETINES

3.1 Patients shall complete the ESAS-r with guidance from Nursing Staff/Physicians, especially on the
first occasion.

3.2 Patients shall be instructed to rate the severity of each symptom from 0 to 10, where 0 represents
absence of the symptom and 10 represents the worst possible severity.

Page 1 of 11
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p+rriiJl po+i'
HealthUNsJl
Qassim Cluster

Policy Title usE oF EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS-R)

lssuing Body Policy Number Replaces No. Policy Leve!

Model of Care qHc-Moc-PP-042-E-V1 New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
2210812022 2s10812022 221O812O24 tt Hospital

3.3 Patients shall be instructed to rate each symptom according to how they currently feel. Nursing
Staff/Physicians may choose to ask additional questions about the severity of symptoms at other time
points e.g. symptom severity at best and at worst over the past 24 hours.

3.4 Nursing Staff/Physicians must ensure that the patient has a full understanding of the what is
inferred by each symptom and where necessary additionally use the definitions that are included under
certain symptoms:

3.4.1 Tiredness: lack of energy

3.4.2 Drowsiness: feeling sleepy

3.4.3 Depression: feeling sad

3.4.4 Anxiety: feeling nervous wellbeing - how you feel overall

3.5 When indicated, patients shall be instructed to use the body diagram on the reverse side of the
ESAS-r to indicate sites of pain.

3.6 Nursing/Staff Physicians shall transfer the scores given by the patient on to the ESAS-r graph.

3.7 The ESAS-r shall be completed for palliative care patients at home as follows:

3.7.1 Each time the patient is contacted by telephone or in person

3.7.2 Weekly if symptoms are in good control, and there are no predominant psychosocial
issues

3.8 For all admitted palliative care patients the ESAS-r shall be completed on admission and thereafter
weekly

3.9 ln other settings, palliative care consultants' shall utilize the ESAS-r upon initial assessment and at
each follow-up visit.

3.10 ln situations where the patient is unable to independently provide ratings of symptom severity but
can still provide input (e.g. when the patient is mildly cognitively impaired), then the ESAS shall be

Page 2 ol ll
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p*rrfll po+i'
HealthUur:Jl
Qassim Cluster

Policy Title usE oF EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS-R)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care QHC-MOC-PP-042-E-V1 New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
221O812O22 2sl08l2o22 2210812024 11
Hospital

completed with the assistance of a caregiver (a family, friend, or health professional closely involved in
the patient's care).

3.111n situations where the patient cannot participate in the symptom assessment at all, or refuses to do
so, the ESAS-r shall be completed by the caregiver alone. He/she shall be asked to assess symptoms as
objectively as possible using the following objective indicators:

3.11.1 Pain: grimacing, guarding against painful maneuvers

3.tL.2 Tiredness: increased amount of time spent resting

3.11.3 Drowsiness: decreased level of alertness

3.17.4 Nausea: retching or vomiting

3.11.5 Appetite: quantity of food intake

3.11.6 Shortness of breath: increased respiratory rate or effort that appears to causing distress to
the patient.

3.tL.7 Depression: tearfulness, flat affect, withdrawalfrom social interactions, irritability, decreased
concentration and/or memory, disturbed sleep pattern

3.11.8 Anxiety: agitation, flushing, restlessness, sweating, increased heart rate intermittent),
shortness of breath

3.11.9 Wellbeing: how the patient appears overall.

3.LZ lf it is not possible to rate a symptom, the caregiver shall be instructed to indicate "U" for
"Unable to assess" on the ESAS-r and ESAS-r Graph.

4. ASSESSMENT AND MANAGEMENT

4.1 Discuss ESAS-r with the patient and explain its use.

Page 3 of 11
 F*Efll pof,i
Healtht'lr:rajl
Qassim Cluster

Policy Title usE oF EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS-RI

lssuing Body Policy Number Replaces No. Policy Level

Model of Care QHC-MOC-PP-042-E-V1 New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
2210812022 2slo8l2022 221O812O24 11
Hospital

4.2 Ask the patient to rate each symptom from 0 - 10 and to circle the corresponding number on the
scale.

4.2.L lf the patient is unable or unwilling to complete the ESAS-r seek input from the patient's caregiver.

4.3 Clarify the meaning of any symptoms that the patient/caregiver is unsure of

4.4 Advise the patient, when applicable, to mark their sites of experienced pain on the body drawings

4.5 Mark the given scores of the ESAS-r graph

4.6 lndicate who completed the form by placing a checkmark against the relevant individual in the
space provided at the bottom ofthe ESAS-r and the ESAS-r graph.

4.7 lnsert the following letter keys at the base of the ESAS-r graph to indicate who completed the
assessment:

4.7.7 P= Patient

4.7.2 F = Family caregiver

4.7.3 H = Health care professional caregiver

4.7.4 A = Caregiver-assisted

4.8 Enter the Palliative Performance Scale (PPS) in the provided space. [see Palliative Performance
Scale (PPS)I

5 APPENDlX

5.1 Appendix 1: Edmonton Symptom Assessment System: (revised version) (ESAS-R) - English

5.2 Appendix 2: Edmonton Symptom Assessment System: (revised version) (ESAS-R) - Arabic

Page 4 of 11
 7

-1
p+,trfll go;i
,4 Healthtlrrall
Qassim Cluster

Policy Title usE oF EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS-R)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care QHC-MOC-PP-042-E-V1 New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
221O812O22 2sl08l2O22 2210812024 LL
Hospital

APPENTXX 1: ESAS EIGLISH VERSION

L.elmonlon 31"m1rtom Arsers[rent Syslem

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r lo \l orst Porrlblr
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of Br"rlh shoa lDelr of lt!'erlh

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Page 5 of 11
\

F,r:6JI po+i'
7 Healthtltltall
Qassim Cluster

Policy Title usE oF EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS-R)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care QHC-MOC-PP-042-E-V1 New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
2210812022 2sl08l2O22 2210812024 LL
Hospital

Phrre urrl otr lher. plclltrer wt.re l] b lb.a l'ou hurt:

'rt
I

Ridll Right

Page 5 of 11
 p*lrillgo+i'
Healthtltlr:Jl
Qassim Cluster

Policy Title usE oF EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS-R)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care QHC-MOC-PP-042-E-V1 New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
2210812022 2s10812022 2210812024 11
Hospital

APPENDIX 2: ESAS ARABIC VERSION

Edmol:lou S]'lrrptom A]s"r]mul St\lrm:

(Rcr{rcd I'c[slo[) (ES.{,S-R)
L).1 I c

Depte\.totr

.\ri\r€I \

.{[)lrltle r

Shorers of
trgirh

( ,ilrtt ".s*

L.lEl of ErliEa!fi

Page 7 of 11
 p*lriJl po+i'
Healthr.lr:lreJl
Qassim Cluster

Policy Title usE oF EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS-R)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care qHc-Moc-PP-042-E-V1 New Cluster
Approval Date Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
2210812022 2sl08l2o22 2210812024 tt Hospital

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(L+tr;eie- )

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Page 8 of 11
 p+Jefll po+i'
,7- HealthUurrll
Qassirn (luster

Policy Title usE oF EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS-R)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care qHc-Moc-PP-042-E-V1 New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
2210812022 2sl08l2O22 221O812O24 11
Hospital

.g ,! Jjr J'l -bF;-:r J.i .. .'-+

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Page 9 of 11
 1
77
7
7 g*rriiJl po+i'
HealthUr:rdl
Qassim Cluster

Policy Title usE oF EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS-R)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care QHC-MOC-PP-042-E-Vl New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
2210812022 2sl08l2O22 2210812024 11
Hospital

ojiiJ.ri drrir11r:
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Page 10 of 11
\
prraiill go+,i
-1
Health\nrdl
Qassim Cluster

Policy Title usE oF EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS-R)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care QHC-MOC-PP-042-E-V1 New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
221O812022 2slo8l2022 2210812024 11
Hospital

1. APPROVAL PROCEDURES

Prepared by:

Name Title Signature Date

Dr.Musaad Aljaloud Project Manager ;('' L5/2/z"zz-
Ms.Rabaih Alfrhidiy ?5-8-L<
Project Manager +@uf>
Reviewed by:

Name Title Signature Date

Dr. Ahmad Saeed Almutairi

Consultant of Family
Medicine, MoC Lead rw
/->
Dr. Loai Alhamad Service Line Lead

Dr.Sultan Alanazi
Director of Therapeutic
4
.s
Services Department

Dr. Abdulelah Alhudaithi VP Of Health Care Delivery

Chairman, Standardization
X rrrr. Ayed Awadh AtReshidi
Steering Committee

Approved by:

Name Title Signature Date

President, Qassim Health

Dr. Sultan Saud Alshaya
Cluster - ,-

Page 11 of 11