title: Attitudes of oncologists towards palliative care and the Edmonton Symptom Assessment System (ESAS) at an Ontario cancer center in Canada.
abstract: BACKGROUND
  Cancer Care Ontario promotes the Edmonton Symptom Assessment System (ESAS) for standardized systematic screening and assessment of symptoms across cancer centers in Ontario, Canada. Attitudes of medical oncologists (MOs), radiation oncologists (ROs), and general practitioners in oncology (GPOs) toward palliative care, and the ESAS were surveyed in Ottawa.
  
  
  METHODS
  A four-part questionnaire was developed, drawing on items from similar studies.
  
  
  RESULTS
  Forty respondents (17 MOs, 16 ROs, and 7 GPOs) were interviewed. Attitudes to palliative care: regarding coordination of care across the illness trajectory including end of life by MOs, all ROs disagreed while 71.4 % of GPOs and 41.2 % of MOs agreed that this was the MO's role. Most respondents supported palliative care alongside concurrent anti-tumor therapies (82.4 % MOs, 62.5 % ROs, and 100 % GPOs). Attitudes to ESAS: respondents agreed that the ESAS enhances care and assessment of symptom severity. ROs felt that reviewing the ESAS histogram was less useful than did MOs (42.9 versus 76.5 %, respectively); 56.3 % of ROs and 88.2 % of MOs agreed that the ESAS is useful for follow-up (p < 0.08); 64.7 % of MOs, 88.3 % of GPOs, and 6.3 % of ROs agreed with ESAS completion at every visit (p < 0.00). Frequency of use of the ESAS: 62.5 % of respondents reported inspecting the ESAS "most of the time or always," while 17.5 % reported "never" or "rarely."
  
  
  CONCLUSIONS
  MOs and GPOs appear more positive than ROs toward regular use of ESAS. There is discordance between what is perceived to be a useful beneficial instrument versus actual use of the instrument in daily practice. The reasons for this gap need to be better understood in future studies.
authors.affiliation: Division of Palliative Care, Élisabeth Bruyère Hospital, Ottawa, Canada, MChasen@bruyere.org.
authors.forename: Martin
authors.initials: M
authors.lastname: Chasen
authors.forename: Ravi
authors.initials: R
authors.lastname: Bhargava
authors.forename: Catherine
authors.initials: C
authors.lastname: Dalzell
authors.forename: José Luis
authors.initials: JL
authors.lastname: Pereira
mesh_terms: D000367:Age Factors; D001291:Attitude of Health Personnel; D002170:Canada; D002173:Cancer Care Facilities; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008495:Medical Oncology; D009369:Neoplasms / Q000628:therapy*; D009864:Ontario; D010166:Palliative Care / Q000523:psychology*; D010820:Physicians / Q000523:psychology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D063189:Symptom Assessment / Q000523:psychology / Q000592:standards; D013727:Terminal Care / Q000523:psychology; D000078329:Workforce