A Voice for Change: Implementing the ESAS tool into our quality platform to allow hospice patients in Ontario to have a voice in their care during the last stage of life



Annalise Stenekes
Manager of Hospice Services at Hospice Palliative Care Ontario.


Hospice Palliative Care Ontario (HPCO) is the active voice that represent and supports all the hospices in Ontario and the individuals who require care. Our organization centres on improving the quality of life for both patients and families who are living with chronic illnesses and bereavement. 

Our vision is to be the unified voice of collaborative, quality hospice palliative care in Ontario. 

Our mission is to provide leadership on behalf of our members by informing policy and promoting awareness, education, knowledge transfer and best practices in the pursuit of quality hospice palliative care in Ontario.

A Voice for Change is a patient centred system that measures the patient’s care to allow ultimate satisfaction with their healthcare needs and wishes. It is a quality platform that allows hospice patients to have a voice and share their thoughts about the hospice palliative care they receive. Quality management is the focus for this initiative with the purpose to promote best practice through the lens of the patient. This strategic initiative allows the patient to direct the care they desire and give them a voice for change.

As a subset to this system, we would like to develop a new component to this system based on the Edmonton Symptom Assessment Scale (ESAS). ESAS is a validated tool designed to assist in the assessment of various symptoms, including: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, wellbeing, and shortness of breath. The patient provides direct insight on how they are currently experiencing pain and other symptoms. Through this process, the hospice staff are then able to review the scores and determine if symptom pains are high, which allows for a targeted intervention to alleviate the symptoms. The goal of this assessment is to evaluate how the patient is doing and what their desired end of life care is. HPCO provides the hospices an informative analytical report based on ESAS results, which allows the hospice to ensure that quality care is delivered. It will also demonstrate the impact that hospice care has on the alleviation of symptoms.