Aims There is currently no tool available to capture symptom control in the dying. The Edmonton Symptom Assessment Scale (ESAS) has been validated for patient and care giver-rated scoring of patients' symptoms, enabling recording to continue as patients deteriorate. However, it has not been used specifically to measure symptoms in the last days of life. The aim was to assess the utility of ESAS in scoring symptoms in the dying patient as measured by completion rates in a ‘before and after’ study investigating the impact of an end-of-life (EOL) care tool.
Methods 70 patients were recruited; 40 before and 30 following the introduction of the EOL tool. Nursing staff were asked to complete 12-hourly ESAS scores from the time the ‘diagnosis of dying’ was made until death.
Results 54% of the ESAS forms were completed but some were not fully scored. 77% of patients recruited had an ESAS form completed in the last 24 h of life. The number of patients with a score for each of the individual symptoms within ESAS varied in both groups. Core EOL symptoms (pain, shortness of breath, nausea, chest secretions and agitation) were scored more frequently when the EOL tool was in place. The frequency of completion of these core symptoms ranged from 75–97% for patients receiving care directed by the EOL tool versus 28–58% for patients receiving usual care.
Conclusion The proportion of missing data suggests 12 hourly symptom scoring was onerous for ward staff. The improved completion rate for core EOL symptoms suggests either that the introduction of the tool improved the nurses' ability or confidence to measure symptoms, or that scoring improved because the task was ‘learnt’ during the study. A shortened ESAS containing only core EOL symptoms might have better utility as an outcome measure for the last days of life.
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