A Review of the Reliability and Validity of the Edmonton Symptom Assessment System

Lyndsay A Richardson, Glenn W Jones


Background: Systematic symptom reporting by patients and using questionnaires such as the Edmonton Symptom Assessment System (ESAS) has potential to improve clinical encounters and patient satisfaction. We review findings from published studies of ESAS to guide its use and focus research.

Methods: A systematic search for articles from 1991 through 2007 found 39 peer-reviewed papers from 25 different institutions, 33 of which focused on patients with cancer. Observations, data, and statistics were collated according to relevance, reliability, validity and responsiveness.

Results: Findings apply predominantly to symptomatic, palliative patients with advanced cancers, and who are no longer receiving active oncologic therapies. Uncertainty about summarizing findings arises from frequent modification of ESAS (altered items, scales, and time-frames). Overall, reliability is established for daily administration. Scores are skewed with a floor effect, but the relative order of symptoms by mean scores is similar across studies. Emotional symptoms are poorly captured by the items of depression and anxiety. An equally weighted summation of scores may estimate a construct of “physical symptom distress”, which in turn is related to performance status, palliative goals, quality of life and well-being.

Conclusions: ESAS is reliable but has restricted validity, and its use requires a sound clinical process to help interpret scores and to give them an appropriate level of attention. Research priorities are to further develop ESAS for assessing a greater number of important physical symptoms (and target “physical symptom distress”), and to develop a similar instrument for emotional symptoms.

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DOI: http://dx.doi.org/10.3747/co.v16i1.261

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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)