Alsuliman Hassan R, Alsaigh Sukaynah A, Habib Faisal A, Alshehery Maied Z
Department of Palliative Medicine, King Fahad Medical City, Riyadh, SAU.
Cureus. 2024 Oct 6;16(10):e70914. doi: 10.7759/cureus.70914. eCollection 2024 Oct.
One of the most essential elements of providing high-quality palliative care is good symptom control, which is guided through an assessment of the evolution of the patient's level of distress over time. The Edmonton Symptom Assessment System (ESAS) was created to measure diverse symptoms in palliative care patients. It is a user-friendly, validated, and reliable multi-item instrument. Globally, ESAS is extensively used to direct daily clinical care and foster communication across multidisciplinary teams, ensuring coordinated patient management, facilitating referrals to specialized programs, and evaluating the quality of care. In this systematic review, we aim to evaluate the influence of using ESAS on symptom assessment and control among palliative care patients and settings. We have employed both manual and electronic search strategies among databases to determine relevant studies. This systematic review included original studies published between 2013 and 2023 that implemented the ESAS as part of palliative care for adult patients with terminal illness or advanced disease. Studies recruiting pediatric patients, case reports with limited sample sizes and no descriptive statistics, and nonhuman or laboratory studies were excluded. The ROBINS-I (Risk Of Bias In Non-randomized Studies-of Interventions) tool was used to assess the quality of the included studies, which assessed the methodological quality and potential risk of bias in non-randomized clinical studies. We included eight studies that recruited a total of 3184 patients. Fatigue followed by pain were the symptoms with the highest score on ESAS among all the studies, while the lowest score was recorded for nausea and dyspnea in most of the studies. ESAS scores showed improvement in the follow-up visits. Two of the included studies reported satisfaction with the utilization of the ESAS tool. As stated in our results, it can improve the overall quality of life for patients receiving palliative care by assisting healthcare professionals, family members, and caregivers in methodically assessing and treating symptoms over time. By fostering better communication among care teams and involving caregivers in the process, the use of ESAS promotes a more patient-centered approach to care, ensuring that both the patient's needs and the perspectives of their loved ones are considered.
提供高质量姑息治疗的最基本要素之一是良好的症状控制，这是通过评估患者痛苦程度随时间的演变来指导的。埃德蒙顿症状评估系统（ESAS）旨在测量姑息治疗患者的各种症状。它是一种用户友好、经过验证且可靠的多项目工具。在全球范围内，ESAS被广泛用于指导日常临床护理，并促进多学科团队之间的沟通，确保患者得到协调管理，便于转诊至专门项目，并评估护理质量。在本系统评价中，我们旨在评估使用ESAS对姑息治疗患者及其所处环境中症状评估和控制的影响。我们在数据库中采用了手动和电子搜索策略来确定相关研究。本系统评价纳入了2013年至2023年间发表的原始研究，这些研究将ESAS作为晚期疾病或绝症成年患者姑息治疗的一部分。招募儿科患者的研究、样本量有限且无描述性统计数据的病例报告以及非人类或实验室研究均被排除。ROBINS-I（干预性非随机研究中的偏倚风险）工具用于评估纳入研究的质量，该工具评估非随机临床研究的方法学质量和潜在偏倚风险。我们纳入了八项研究，共招募了3184名患者。在所有研究中，疲劳其次是疼痛是ESAS得分最高的症状，而在大多数研究中，恶心和呼吸困难得分最低。ESAS得分在随访中有所改善。两项纳入研究报告了对ESAS工具使用的满意度。如我们的结果所示，它可以通过协助医护人员、家庭成员和护理人员随着时间的推移有条不紊地评估和治疗症状，提高接受姑息治疗患者的总体生活质量。通过促进护理团队之间更好的沟通并让护理人员参与这一过程，ESAS的使用促进了一种更以患者为中心的护理方法，确保既考虑患者的需求，也考虑其亲人的观点。
