Palliative Assessment

Symptom-focused palliative care assessment using the Edmonton Symptom Assessment System-revised (ESAS-r) alongside performance status, goals-of-care documentation, medication and symptom-control planning, and psychosocial and spiritual review, to guide individualized palliative management.

Scoring

Instrument: ESAS-r — 10 symptoms each rated 0–10, total 0–100.

• None (0–10) — minimal symptom burden.
• Mild (11–30) — low burden; routine review.
• Moderate (31–60) — meaningful burden; escalate symptom control.
• Severe (61–100) — high burden; urgent review/hospice referral.
• Individual flag: any single symptom ≥ 7 triggers urgent single-symptom review regardless of the total.

What it covers

Demographics; primary diagnosis and prognosis; ESAS-r symptom scoring; performance status (PPS/KPS/ECOG); goals of care and advance care planning documents; medications and symptom-control plan; psychosocial and spiritual concerns; carer and family support; and a multidisciplinary plan with referrals.

Common pitfalls

• Averaging away a single severe symptom in the total score — the individual-symptom flag (≥ 7 on any item) exists precisely because a moderate total can hide one severely distressing symptom that needs urgent attention on its own.
• Treating goals-of-care documentation as a one-time conversation — goals of care evolve as disease progresses; the documentation should be revisited, not fixed at the first assessment.
• Skipping spiritual and psychosocial review because the focus is physical symptoms — these domains materially affect a patient's experience and are core, not supplementary, to palliative assessment.

Learn more

• FormExamples: palliative-assessment for the full implementation, clinical references, and worked examples.
• Oncology Assessment for a related assessment relevant to advanced cancer.