title: Cancer Care Professionals' Attitudes Toward Systematic Standardized Symptom Assessment and the Edmonton Symptom Assessment System After Large-Scale Population-Based Implementation in Ontario, Canada.
abstract: BACKGROUND
  Cancer patients experience a high symptom burden throughout their illness. Despite this, patients' symptoms and needs are often not adequately screened for, assessed, and managed.
  
  
  OBJECTIVE
  This study investigated the attitudes of cancer care professionals toward standardized systematic symptom assessment and the Edmonton Symptom Assessment System (ESAS) and their self-reported use of the instrument in daily practice in a large healthcare jurisdiction where this is routine.
  
  
  METHODS
  A 21-item electronic survey, eliciting both closed and open-ended anonymous responses, was distributed to all 2806 cancer care professionals from four major provider groups: physicians, nurses, radiotherapists, and psychosocial oncology (PSO) staff at the 14 Regional Cancer Centres across Ontario, Canada.
  
  
  RESULTS
  A total of 1065 questionnaires were returned (response rate: 38%); 960 were eligible for analysis. Most respondents (88%) considered symptom management to be within their scope of practice. Sixty-six percent of physicians considered the use of standardized tools to screen for symptoms as "best practice," compared to 81% and 93% of nurses and PSO staff, respectively. Sixty-seven percent of physicians and 85% of nurses found the ESAS to be a useful starting point to assess patients' symptoms. Seventy-nine percent of physicians looked at their patient's ESAS scores at visits either "always" or "often," compared to 29%, 66%, and 89% of radiotherapists, PSO staff, and nurses, respectively. Several areas for improvement of ESAS use and symptom screening were identified.
  
  
  CONCLUSIONS
  Findings show significant albeit variable uptake across disciplines in the use of the ESAS since program initiation. Several barriers to using the ESAS in daily practice were identified. These need to be addressed.
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada; Bruyère Continuing Care, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada. Electronic address: jpereira@bruyere.org.
authors.forename: José L
authors.initials: JL
authors.lastname: Pereira
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada; Bruyère Continuing Care, Ottawa, Ontario, Canada.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Chasen
authors.affiliation: St. Joseph's Health Centre, Toronto, Ontario, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: Molloy
authors.affiliation: Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Heidi
authors.initials: H
authors.lastname: Amernic
authors.affiliation: Cancer Care Ontario, Toronto, Ontario, Canada; Queen's University, Kingston, Ontario, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Brundage
authors.affiliation: Canadian Partnership Against Cancer, Toronto, Ontario, Canada.
authors.forename: Esther
authors.initials: E
authors.lastname: Green
authors.affiliation: Ontario Renal Network, Toronto, Ontario, Canada.
authors.forename: Serena
authors.initials: S
authors.lastname: Kurkjian
authors.affiliation: Cancer Care Ontario, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Ontario Cancer Institute, Toronto, Ontario, Canada.
authors.forename: Monika K
authors.initials: MK
authors.lastname: Krzyzanowska
authors.affiliation: Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Wenonah
authors.initials: W
authors.lastname: Mahase
authors.affiliation: Cancer Care Ontario, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
authors.forename: Omid
authors.initials: O
authors.lastname: Shabestari
authors.affiliation: Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Reena
authors.initials: R
authors.lastname: Tabing
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Klinger
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D009864:Ontario; D057566:Self Report; D063189:Symptom Assessment / Q000379:methods* / Q000523:psychology*
keywords: Cancer professionals; ESAS; Edmonton Symptom Assessment System; PROM; PROs; patient-reported outcome measurement; patient-reported outcomes; systematic symptom assessment