Evaluation of the Utility of the Edmonton Symptom Assessment System (revised) Scale on a Tertiary Palliative Care Unit.

AIM: The aim of this study was to evaluate the utility of the Edmonton Symptom Assessment System (ESAS-r) Scale on a tertiary palliative care unit. METHOD: There were 92 admitted patients who participated in the study; the scale was administered to those able to participate on day 1 (n = 35, 38 percent), on day 4 (n = 20, 21 percent), and weekly. Patient comfort level with the ESAS-r tool was assessed using a 5-point Likert scale (strongly disagree to strongly agree) on day 4. Nurses' and physicians' perceptions of clinical assessment pre- and postimplementation of the scale were surveyed using a 5-point Likert scale. RESULTS: Of the participating physicians, 75 percent (n = 3) found that the ESAS-r Scale did not enhance clinical assessment; the proportion of nurses with that response was 37.5 percent (n = 6). Among these care providers, 50 percent of the physicians (n = 2) and 62 percent of the nurses (n = 10) thought that the scale was burdensome to patients; but 60 percent of the patients who were able to complete the comfort-level survey (n = 12) indicated that they did not find the scale burdensome. CONCLUSION: Patient acuity, team expertise, perceived burden to patients, and time commitment all influenced staff's recommendation not to implement the ESAS-r tool on the palliative care unit.

Principles of pain management in advanced prostate cancer.

Quality of life can be enhanced in patients with advanced prostate cancer by managing pain effectively. It is important to recognize that palliative care does not imply terminal care and that urologists, oncologists, family practitioners, and palliative care specialists should coordinate their care with the patient and family to optimize treatment. This paper focuses on the correct use of opioids and adjuvants in the management of prostate cancer, and addresses the management of side effects of opioid administration.