Dr. Deb Hairr, DHS, MSN, RNC
The article discusses that the symptoms of hospice patients often fluctuate with time. This makes it essential to track patients longitudinally and record their symptom decline or progress. Accordingly, Edmonton Symptom Assessment System (ESAS) is to be administered at each clinic visit to record any symptom fluctuations. The article suggests further refinements to ESAS including integrating ESAS in electronic health records, coupling ESAS with individualized symptom goals to optimize symptom response assessment, and utilizing ESAS as a trigger for palliative care referral.
Richardson, L.A; Jones, G.W. (2009). A review of the reliability and validity of the Edmonton Symptom Assessment System. Curr Oncol, 16 (1): 55-70.
This article discusses that ESAS is consistent but its validity is limited, and its utilization needs a logic clinical procedure to assist in interpreting the scores and provide a suitable level of attention. The authors establish that emotional symptoms are normally poorly captured using the depression and anxiety items. This is because the emotional components in ESAS are underdeveloped and need general adjustment. The authors suggests a separate tool to be developed that is similar to ESAS, which addresses more than ten emotional symptoms using nonpsychiatric labels and include symptoms representing additional disorders than just depression and anxiety.
Pereira, J.L., Chasen, M.R., Molloy, S., Amernic, H., & Brundage, M.D. et al. (2016). Cancer Care Professionals’ Attitudes Toward Systematic Standardized Symptom Assessment and the Edmonton Symptom Assessment System After Large-Scale Population-Based Implementation in Ontario, Canada: Systematic Standardized Symptom Assessment, Journal of Pain and Symptom Management, 51 (4): 1-19.
The article states that some hospice patients do not understand aspects of the ESAS, hence can find difficulty completing it. This necessitates healthcare professionals and patients to be coached on the way to use the instrument properly. The authors claim that a person centered approach to care focuses on the call for for care providers to recognize and take into consideration the needs, preference, and illness experience of the patient. The article therefore suggests that the use of ESAS should be aligned with person centered approach to care, and acknowledge and address patient needs.
Rauenzahn, S.L., Schmidt, S., Aduba, I.O., Jones, J.T, Ali, N., & Tenner, L.L. (2017). Intehrating Paliative Care Services in Ambulatory Oncology: An Application of the Edmonton Symptom Assessment System. Journal of Oncology Practice 13 (4): 621-710.
The authors affirm that symptom burden still remains equally high from initial to follow-up encounters. Misunderstanding of the advantages of palliative care services is the greatest barrier to proper use of ESAS. This requires potential criteria to construct and apply a trigger that is supported on patient-rated symptom scores to assist patents and care providers manage symptoms. The article suggests the utilization of ESAS instrument with an electronic medical record-based provider alert that documents a predefined percentage of patients towards improving palliative care, symptom improvement as well as patient outcomes.
Garyali, M.D., Palmer, L., Sriram, Y., Zhang, T., Pace, E.A., & Bruera, E. (2006). Errors in Symptom Intensity Self-Assessment by Patients Receiving Outpatient Palliative Care. Journal of Palliative Medicine, 9 (5): 1059-1065.
The article discusses that there is a possibility of error if nurses do not monitor routinely the way patients have completed ESAS form. It is necessary to be cautious regarding the ESAS scores that are performed by the patients especially for symptoms of appetite, sleep, and pain. The authors suggest that nurses need to carry the ESAS symptom score into rooms of patients and review symptom outcomes to make sure there is consistency. Symptom intensity assessment is very important in minimizing measurement errors among hospice patients since it assists to guide patient care.
Brandyn, D.Q; Aslakson, RA; Wilson, RF; Fawole, OA, et al. (2013). Methods of Improving the Quality of Palliative Care Delivery: A Systematic Review. The American Journal of Hospice & Palliative Care, 31 (2): 202-210.
The article discusses what patients experience with aggressive treatment in the last weeks of life. Palliative care is delayed until the last days of a patient’s life, and this results in palliative care used to manage death instead of treating the symptoms. The delay is caused by decreased access to palliative care, and fewer skilled nurse follow-ups on patients with complex and severe illness. The authors propose that timely care is necessary along with clinical information, caregiver and patient education, and individual-management.
Stilos, K; Wynnychuk, L; DasGupta, T; Lilien, T. (2016). Improving end-of-life care through quality Improvement. International Palliative Nursing, 22 (9): 430-434.
The article discusses that gaps exist in the quality of care given to imminently dying patients. This requires a high quality of care for dying patients and their families. Also, the care of imminently dying patients is ordinarily complex and requires skilled nurses. The author proposes that quality improvement interventions include; staff education and patient and family education.
Rawlings, D; Devery, K; Poole, N. (2019). Improving quality in hospital end-of-life-care: honest communication, compassion and empathy. BMJ Open Quality, 8 (2).
The authors propose that quality end-of-life care is hard to achieve if hospitals lack a workforce not trained to care for over half of the expected deaths that occur in their facilities. The authors claim that education is essential but cannot bring change by itself. It needs to be offered in combination with a practice toolkit that provides nurses with feasible ways to transform their practice continually. This can be through interventions such as communication, professional mind-set, professional practice, and patient-centered care.
Sinuff, T; Dodek, P; You, J.J; Barwich, D; Tayler, C; Downar, J. (2015). Improving End-of-Life Communication and Decision Making: The Development of a Conceptual Framework and Quality Indicators. Journal of Pain and Symptom Management 49 86): 1070-1080.
The authors affirm that there are still significant gaps in end-of-life communication for decision making for expected deaths. Communication and decision-making in the end-of-life aim to develop a shared understanding concerning a person’s values and treatment preferences. This leads to a plan of care that is consistent with the outlined values and preferences. Quality indicators connected to end-of-life communication and decision making include advanced care planning, proper documentation, proper organizational structures, and proper goals of care discussions.
Dobson, J. (2017). Providing high-quality care at the end of life; the role of education and guidance. British Journal of Nursing, 26 (20), 1116-1120.
The article discusses that Palliative care has been deteriorating as staff lack the needed knowledge of caring for dying patients. Those approaching the end of life deserve optimal care, attention, consideration, and compassion, yet this is not often the case. The article suggests that care of the dying must be based on individualized care planning for the patient approaching end-of-life. Additionally, nurses need to be trained further on how to care for dying patients.
References
Brandyn, D.Q; Aslakson, RA; Wilson, RF; Fawole, OA, et al. (2013). Methods of Improving the Quality of Palliative Care Delivery: A Systematic Review. The American Journal of Hospice & Palliative Care, 31 (2): 202-210.
Dobson, J. (2017). Providing high-quality care at the end of life; the role of education and guidance. British Journal of Nursing, 26 (20), 1116-1120.
Rawlings, D; Devery, K; Poole, N. (2019). Improving quality in hospital end-of-life-care: honest communication, compassion and empathy. BMJ Open Quality, 8 (2).
Sinuff, T; Dodek, P; You, J.J; Barwich, D; Tayler, C; Downar, J. (2015). Improving End-of-Life Communication and Decision Making: The Development of a Conceptual Framework and Quality Indicators. Journal of Pain and Symptom Management 49 86): 1070-1080.
Stilos, K; Wynnychuk, L; DasGupta, T; Lilien, T. (2016). Improving end-of-life care through quality Improvement. International Palliative Nursing, 22 (9): 430-434.
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