Edmonton Symptom

Assessment Scale (ESAS) Tool

Name:__________________________________________________ Phone Number:______________________

Address:_____________________________________________ Completed By:________________________

Please circle a number that best describes how you feel:

0 1 2 3 4 5 6 7 8 9 10
No pain Worst possible pain
0 1 2 3 4 5 6 7 8 9 10
Not tired Very tired
0 1 2 3 4 5 6 7 8 9 10
No nausea Very nauseous
0 1 2 3 4 5 6 7 8 9 10
Not depressed Very depressed
0 1 2 3 4 5 6 7 8 9 10
Calm Very anxious
0 1 2 3 4 5 6 7 8 9 10
Not drowsy Very drowsy
0 1 2 3 4 5 6 7 8 9 10
Normal appetite No appetite
0 1 2 3 4 5 6 7 8 9 10
Best feeling of well-being Worst possible feeling of well-being
0 1 2 3 4 5 6 7 8 9 10
No shortness of breath Very short of breath
0 1 2 3 4 5 6 7 8 9 10
Other problem
Please mark on these pictures where you feel pain or discomfort.

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Permission to use tool granted by: Edmonton Regional Palliative Care Program, Capital Health, Edmonton, AB, 2004.
Edmonton Symptom
Assessment Scale (ESAS)
The Edmonton Symptom Assessment Scale (ESAS) is a valid and reliable tool to assist in
the assessment of nine common symptoms experienced by cancer patients. The ESAS
is one of the key tools used by Saint Elizabeth Health Care for Oncology and Palliative
Care clients. The original tool was developed by the Regional Palliative Care Program,
Capital Health in Edmonton, Alberta.

PURPOSE OF THE ESAS HOW TO DO THE ESAS

This scale is designed to help assess pain, Take a moment to reflect on your symptoms
tiredness, nausea, depression, anxiety, and choose the most appropriate number to
drowsiness, appetite, well-being, and shortness indicate where the symptom lands on the scale.
of breath. The blank scale can be used to assess You can then write it onto the ESAS Log.
“other problems” as needed. Each symptom’s
0 1 2 3 4 5 6 7 8 9 10
severity at the time of assessment is rated from
0 to 10; 0 meaning the symptom is absent and
10 being the worst possible severity. No pain  Worst possible pain
Some symptoms may be harder to vocalize or
The ESAS was designed so you or your understand. Below are similar words that may
family/caregiver could self-assess symptoms, help you better understand the symptom.
and use this tool to better understand your
symptoms. Your opinion of the severity of ∞ Depression – Feeling sad or blue most of
your own symptoms is the gold standard for the time
symptom assessment.
∞ Anxiety – Feeling nervous or restless
The ESAS provides a clinical profile of
∞ Tiredness – Having lower energy but not
symptom severity over time as well as
necessarily tired
a context for understanding symptoms.
However, it is not a complete assessment ∞ Drowsiness – Feeling sleepy
in itself. For comprehensive symptom
management, the ESAS must be used as one ∞ Well-being – Reflect on your overall
part of a holistic clinical assessment. comfort, both physical and otherwise.
Truthfully answer the question “How
are you?”

If you are in pain, the Body Diagram can be

used to find out where you hurt specifically.
WHO SHOULD COMPLETE THE ESAS WHEN TO DO THE ESAS
Ideally, each person fills out their own ESAS. The ESAS should be completed at every visit
However, if needed it should be completed with to the doctor. It is good practice to complete
assistance by the caregiver (a family member, the ESAS at the same time of day, prior to
friend) or a health professional closely involved your scheduled visit. The ESAS should only
with your care. If you cannot participate in the be completed on a daily basis for those
symptom assessment, the ESAS is completed receiving more than one nursing visit per day;
by the caregiver or professional. however, there may be a symptom(s) requiring
reassessment more than once a day. For
The method in which the ESAS is completed example, if your pain is at a 10 on the morning
must be indicated on the client log as follows: visit, you can call your doctor and they may
by client, caregiver assisted, by caregiver, or by suggest some tools to better manage the
health professional. symptom. The case manager authorizes visits
twice a day for pain control, and at the second
NOTE: visit you reassess the pain.
When the caregiver or professional completes
the ESAS alone, the subjective symptom scales WHERE TO DOCUMENT THE ESAS
are left blank (i.e. tiredness, depression, anxiety,
The ESAS is then transcribed onto the
and well-being) while the caregiver assesses the
Monthly ESAS/PPS Data Collection Form
remaining symptoms as objectively as possible
in the Saint Elizabeth.
(i.e. pain is assessed based on knowledge
of pain behaviours, appetite is interpreted as
the absence or presence of eating, nausea
as the absence or presence of retching or
vomiting, and shortness of breath as laboured
or accelerated breaths that appear to cause the
patient distress).

Permission to use tool granted by: Regional Palliative Care Program, Capital Health Region, Edmonton, Alberta, 2004.
Additional acknowledgement to Kingston Integrated Palliative Care Project, for allowing us to use their user friendly
documents as a guideline, 2004.