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  • Screening For Distress Form - Alberta Health Services

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Affix patient label within this box. Screening for Distress Completed By Patient Family Health Professional Assisted by family/health professional Date (yyyyMondd) Please circle the number that best.

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A questionnaire used to rate the intensity of nine common symptoms experienced by cancer patients, including pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath.

A positive value indicates improvement, while a negative value indicates deterioration. Combined score based on ESAS pain, fatigue nausea, drowsiness, appetite, and dyspnea. The total ranges from 0 to 60, with a higher score indicating higher physical symptom burden. Combined score based on ESAS anxiety and depression.

The assessment is called an ESAS-r, which stands for Edmonton Symptom Assessment System. The ESAS assesses the severity over time of nine symptoms common among patients with cancer and other advanced illness: pain, tiredness, drowsiness, nausea, shortness of breath, appetite, depression, anxiety, and wellbeing.

The ESAS-r retains core elements of the ESAS, with improved interpretation and clarity of symptom intensity assessment. It represents the next generation of ESAS development, with further validation recommended for drowsiness, appetite, and well-being.

Background: The Edmonton Symptom Assessment Scale (ESAS) is a nine-item patient-rated symptom visual analogue scale developed for use in assessing the symptoms of patients receiving palliative care. The purpose of this study was to validate the ESAS in a different population of patients.

In hospice and tertiary palliative care units, the ESAS-r should be completed daily. In other settings, palliative care consultants will utilize this tool upon initial assessment and at each follow-up visit. It is preferable for the patient to provide ratings of symptom severity by himself/herself.

Palliative Performance Scale (PPS) The Palliative Performance Scale was developed by Victoria Hospice and used to measure performance status in palliative care. It measures five key areas: ambulation, ability to do activities, self-care, food/fluid intake, and level of consciousness.

Background: The Edmonton Symptom Assessment Scale (ESAS) is a nine-item patient-rated symptom visual analogue scale developed for use in assessing the symptoms of patients receiving palliative care. The purpose of this study was to validate the ESAS in a different population of patients.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232