Skip to main content

Attitudes of oncologists towards palliative care and the Edmonton Symptom Assessment System (ESAS) at an Ontario cancer center in Canada

Abstract

Background

Cancer Care Ontario promotes the Edmonton Symptom Assessment System (ESAS) for standardized systematic screening and assessment of symptoms across cancer centers in Ontario, Canada. Attitudes of medical oncologists (MOs), radiation oncologists (ROs), and general practitioners in oncology (GPOs) toward palliative care, and the ESAS were surveyed in Ottawa.

Methods

A four-part questionnaire was developed, drawing on items from similar studies.

Results

Forty respondents (17 MOs, 16 ROs, and 7 GPOs) were interviewed. Attitudes to palliative care: regarding coordination of care across the illness trajectory including end of life by MOs, all ROs disagreed while 71.4 % of GPOs and 41.2 % of MOs agreed that this was the MO’s role. Most respondents supported palliative care alongside concurrent anti-tumor therapies (82.4 % MOs, 62.5 % ROs, and 100 % GPOs). Attitudes to ESAS: respondents agreed that the ESAS enhances care and assessment of symptom severity. ROs felt that reviewing the ESAS histogram was less useful than did MOs (42.9 versus 76.5 %, respectively); 56.3 % of ROs and 88.2 % of MOs agreed that the ESAS is useful for follow-up (p < 0.08); 64.7 % of MOs, 88.3 % of GPOs, and 6.3 % of ROs agreed with ESAS completion at every visit (p < 0.00). Frequency of use of the ESAS: 62.5 % of respondents reported inspecting the ESAS “most of the time or always,” while 17.5 % reported “never” or “rarely.”

Conclusions

MOs and GPOs appear more positive than ROs toward regular use of ESAS. There is discordance between what is perceived to be a useful beneficial instrument versus actual use of the instrument in daily practice. The reasons for this gap need to be better understood in future studies.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Barbera L et al (2010) Symptom burden and performance status in a population‐based cohort of ambulatory cancer patients. Cancer 116:5767–5776

    PubMed  Article  Google Scholar 

  2. 2.

    Chang VT et al (2000) Symptom and quality of life survey of medical oncology patients: a role for symptom assessment. Cancer 88:1175–1183

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    White C et al (2009) Now that you mention it, doctor … : symptom reporting and the need for systematic questioning in a specialist palliative care unit. J Palliat Med 12:447–450

    PubMed  Article  Google Scholar 

  4. 4.

    Homsi J et al (2006) Symptom evaluation in palliative medicine: patient report vs systematic assessment. Support Care Cancer 14:444–453

    PubMed  Article  Google Scholar 

  5. 5.

    Dudgeon DJ, Knott C, Chapman C et al (2009) Development, implementation, and process evaluation of a regional palliative care quality improvement project. J Pain Symptom Manag 38:483–495

    Article  Google Scholar 

  6. 6.

    Bruera E, Kuehn N, Miller MJ et al (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9

    CAS  PubMed  Google Scholar 

  7. 7.

    Nekolaichuk C, Watanabe S, Beaumont C (2008) The Edmonton Symptom Assessment System: a 15-year retrospective review of validation studies (1991–2006). Palliat Med 22:111–122

    PubMed  Article  Google Scholar 

  8. 8.

    Glasgow RE, Kaplan RM, Ockene JK et al (2012) Patient-reported measures of psychosocial issues and health behavior should be added to electronic health records. Health Aff (Millwood) 31:497–504

    Article  Google Scholar 

  9. 9.

    Pereira J, Green E, Molloy S et al (2014) Population-based standardized symptom screening: Cancer Care Ontario’s Edmonton Symptom Assessment System and Performance Status Initiatives. J Oncol Pract 3:212–214

    Article  Google Scholar 

  10. 10.

    Bainbridge D, Seow H, Sussman J, Pond G, Martellis-Reid L, Herbert C, Evans W (2011) Multidisciplinary health care professionals’ perceptions of the use and utility of a symptom assessment system for oncology patients. J Oncol Pract 7:19–23

    PubMed Central  PubMed  Article  Google Scholar 

  11. 11.

    Cancer Care Ontario (2013) Cancer Care Ontario Symptom Management Tools. https://www.cancercare.on.ca/toolbox/symptools/. Accessed 20 October 2013

  12. 12.

    Cherny NI, Catane R (2003) Attitudes of medical oncologists toward palliative care for patients with advanced and incurable cancer. Cancer 98:2502–2510

    PubMed  Article  Google Scholar 

  13. 13.

    Core Team R (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  14. 14.

    Agresti A, Coull BA (1998) Approximate is better than “exact” for interval estimation of binomial proportions. Am Stat 52:119–126

    Google Scholar 

  15. 15.

    May WL, Johnson WD (2000) Constructing two-sided simultaneous confidence intervals for multinomial proportions for small counts in a large number of cells. J Stat Softw 5:1–24

    Google Scholar 

  16. 16.

    World Health Organization (2004) WHO definition of palliative care. http://www.who.int/cancer/palliative/definition/en/. Accessed 20 October 2013

  17. 17.

    Temel JS et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Brown CG (2011) The barriers to and evidence for palliative care. J Pediatr Hematol Oncol 33:132–135

    Article  Google Scholar 

  19. 19.

    Ahmed N, Bestall JE, Ahmedzai SH et al (2004) Systematic review of the problems and issue of accessing specialist palliative care by patients, careers and health social care professionals. Palliat Med 18:525–542

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Barbera L et al (2013) Do patient-reported symptoms predict emergency department visits in cancer patients? A population-based analysis. Ann Emerg Med 61:427–437

    PubMed  Article  Google Scholar 

  21. 21.

    Dudgeon DJ, Knott C, Eichholz M et al (2008) Palliative Care Integration Project (PCIP) quality improvement strategy evaluation. J Pain Symptom Manag 6:573–582

    Article  Google Scholar 

  22. 22.

    Barbera L, Taylor C, Dudgeon D (2010) Why do patients with cancer visit the emergency department near the end of life? Can Med Assoc J 183:563–568

    Article  Google Scholar 

  23. 23.

    Gilbert JE et al (2012) Quality improvement in cancer symptom assessment and control: the provincial palliative care integration project (PPCIP). J Pain Symptom Manag 43:663–678

    Article  Google Scholar 

  24. 24.

    Ruland CM et al (2010) Effects of a computer-supported interactive tailored patient assessment tool on patient care, symptom distress, and patients’ need for symptom management support: a randomized clinical trial. J Am Med Inform Assoc 17:403–410

    PubMed Central  PubMed  Article  Google Scholar 

  25. 25.

    Fairchild A et al (2008) Palliative thoracic radiotherapy for lung cancer: a systematic review. JCO 26:4001–4011

    Article  Google Scholar 

  26. 26.

    Gunn GB et al (2012) High symptom burden prior to radiation therapy for head and neck cancer: a patient‐reported outcomes study. Head Neck 35:1490–1498

    PubMed Central  PubMed  Google Scholar 

  27. 27.

    Hoegler D (1997) Radiotherapy for palliation of symptoms in incurable cancer. Curr Probl Cancer 21:129–183

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Berry DL, Blumenstein BA, Halpenny B et al (2011) Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial. JCO 29:1029–1035

    Article  Google Scholar 

  29. 29.

    Watanabe S, Nekolaichuk C, Beaumont C, Mawani A (2009) The Edmonton Symptom Assessment System: what do patients think? Support Care Cancer 17:675–683

    PubMed  Article  Google Scholar 

  30. 30.

    Cancer Quality Council of Ontario (2013) Symptom Assessment and Management - CSQI 2013. http://www.csqi.on.ca/cms/one.aspx?portalId=258922&pageId=272723#.Uv5WGvldV1Y. Accessed 20 October 2013

  31. 31.

    Smith T, Temin S, Alesi E et al (2012) American Society of Clinical Oncology Provisional Clinical Opinion: the integration of palliative care into standard oncology care. JCO 38:5161

    Google Scholar 

  32. 32.

    Cherny N, Catane R, Kosmidis P et al (2003) ESMO takes a stand on supportive and palliative care. Ann Oncol 14:1335–1337

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Rogers EM (2010) Diffusion of innovations. Simon and Schuster, New York

    Google Scholar 

Download references

Acknowledgments

The authors wish to thank Iftikhar Ahmed for his dedication to this project and interviewing of the participants.

Conflict of interest

The authors have declared no conflicts of interest.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Martin Chasen.

Appendices

Appendix 1

Table 1 Attitudes related to palliative care and palliative care services (Adapted from Cherny et al. [12]; N = 40 (total and by specific group in %)

Appendix 2

Table 2 Attitudes related to the Edmonton Symptom Assessment System (Adapted from Bainbridge et al. [10]; N = 40 (total and by specific group in %)

Appendix 3

Table 3 Frequency of use of the Edmonton Symptom Assessment System (ESAS; N = 40)

Appendix 4

Table 4 Attitudes related to the Cancer Care Ontario (CCO) guidelines and algorithm (N = 40)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chasen, M., Bhargava, R., Dalzell, C. et al. Attitudes of oncologists towards palliative care and the Edmonton Symptom Assessment System (ESAS) at an Ontario cancer center in Canada. Support Care Cancer 23, 769–778 (2015). https://doi.org/10.1007/s00520-014-2411-0

Download citation

Keywords

  • ESAS
  • Symptom assessment
  • Cancer