Your activity: 4 p.v.

Revised Edmonton symptom assessment scale: Numeric scale

Revised Edmonton symptom assessment scale: Numeric scale

Patient name:

Date:

Time:
 
Please circle the number that best describes how you feel NOW:
No pain 0 1 2 3 4 5 6 7 8 9 10 Worst possible pain
No tiredness
(Tiredness = lack of energy)
0 1 2 3 4 5 6 7 8 9 10 Worst possible tiredness
No drowsiness
(Drowsiness = feeling sleepy)
0 1 2 3 4 5 6 7 8 9 10 Worst possible drowsiness
No nausea 0 1 2 3 4 5 6 7 8 9 10 Worst possible nausea
No lack of appetite 0 1 2 3 4 5 6 7 8 9 10 Worst possible lack of appetite
No shortness of breath 0 1 2 3 4 5 6 7 8 9 10 Worst possible shortness of breath
No depression
(Depression = feeling sad)
0 1 2 3 4 5 6 7 8 9 10 Worst possible depression
No anxiety
(Anxiety = feeling nervous)
0 1 2 3 4 5 6 7 8 9 10 Worst possible anxiety
Best wellbeing
(Wellbeing = how you feel overall)
0 1 2 3 4 5 6 7 8 9 10 Worst possible wellbeing
No __________
Other problem (for example, constipation)
0 1 2 3 4 5 6 7 8 9 10 Worst possible __________
Reproduced from: Watanabe SM, Nekolaichuk C, Beaumont C, et al. A multicenter study comparing two numerical versions of the Edmonton Symptom Assessment System in palliative care patients. J Pain Symptom Manage 2011; 41:456. Illustration used with the permission of Elsevier Inc. All rights reserved.
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