Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Edmonton Symptom Assessment System (revised version)
Please circle the number that best describes how you feel NOW:
No pain
1
2
3
4
5
6
7
8
9
10
Worst possible
pain
No tiredness
(Tiredness = Lack of energy)
1
2
3
4
5
6
7
8
9
10
Worst possible tiredness
No drowsiness
(Drowsiness= feeling sleepy)
1
2
3
4
5
6
7
8
9
10
Worst possible drowsiness
No nausea
1
2
3
4
5
6
7
8
9
10
Worst possible nausea
No lack of appetite
1
2
3
4
5
6
7
8
9
10
Worst possible lack of appetite
No shortness of breath
1
2
3
4
5
6
7
8
9
10
Worst possible
shortness of breath
No depression
(Depression= feeling sad)
1
2
3
4
5
6
7
8
9
10
Worst possible depression
No anxiety
(Anxiety= feeling nervous)
1
2
3
4
5
6
7
8
9
10
Worst possible anxiety
Best wellbeing
(Wellbeing= how you feel overall)
1
2
3
4
5
6
7
8
9
10
Worst possible wellbeing
No ____          (e.g. constipation)Other Problem
1
2
3
4
5
6
7
8
9
10
Worst possible
                       
Patient’s name:                        _____________
Date:                                                  
Time:                                                                          
Completed by (check one):
 Patient
 Family caregiver
 Health-care professional caregiver
 Caregiver-assisted

 
Reprinted from Journal of Pain and Symptom Management, Vol. 41, No. 2, Watanabe, S. M., Nekolaichuk, C., Beaumont, C., Johnson, L., Myers J., & Strasser, F., A Multi-Centre Comparison of Two Numerical Versions of the Edmonton Symptom Assessment System in Palliative Care Patients, 456-468, Copyright (2011), with permission from Elsevier.
 
For more information about this tool, please visit: www.palliative.org/PC/ClinicalInfo/AssessmentTools/ESAS%20ToolsIdx.html.