176 Essentials in Hospice and Palliative Care: A Practical Resource for Every Nurse Screen with the Edmonton Symptom Assessment System Use the Edmonton System Assessment System (ESAS) to screen regularly for pain and whenever pain is suspected. Assess with the Symptom Assessment Tool Adapted for Pain Use the Symptom Assessment Tool adapted for pain (Table 17) to conduct a thorough assessment, including a physical assessment, and a review of the person’s history and current relevant reports. Assess Frailty and Inform Goals-of-Care Conversations Assess the person’s frailty using the CSHA Clinical Frailty Scale or the PPS. Consider using the GSF PIG, the SPICT, or tools for prognosticating one-year mortality (see Chap- ter 4, “Using Standardized Tools”) to inform goals-of-care conversations and determine whether investigations are appropriate. Table 17. Symptom Assessment Tool Adapted for Pain Symptom Assessment Tool Adapted for Pain O Onset When did you start experiencing pain? How long does the pain last? P Provoking/Palliating What triggers your pain? How often do you feel the pain each day? What decreases your pain? Is there a pattern to when pain occurs? Does your pain increase the severity of other symptoms? Do other symptoms make your pain feel worse? Q Quality Can you describe the pain, what it feels like? R Region/Radiating Where are you feeling the pain? Any other areas? Are any of your pains radiating to other regions? Are any of your pains causing other symptoms? S Severity Can you rate your pain (discomfort) on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine? Would you prefer to rate your pain with words such as “mild,” “moderate,” or “severe”? T Treatment What medications have you used to control pain? What doses have you tried? What was effective? Did you experience any side effects when you took the medications? Have your medications for managing pain been changed recently? U Understanding What do you think is causing the pain? How is this pain affecting your daily activities? Can you tell me how it is for you to be in pain? V Values What are your goals for pain management? On a scale of 0 to 10, where would you like your pain to be? What is most important to you today? W What Else? • Physical assessment Look for any changes, asymmetry, sounds, areas that are sensitive to touch or that feel warm. If pain involves the abdomen, auscultate, percuss, palpate, and notice any bulges or distention. • Other relevant findings Medications Relevant lab and diagnostic results