CDE Detailed Report
Disease: Amyotrophic Lateral Sclerosis
Sub-Domain: Functional Outcomes
CRF: Edmonton Symptom Assessment System (ESAS)
Displaying 1 - 14 of 14
Sub-Domain: Functional Outcomes
CRF: Edmonton Symptom Assessment System (ESAS)
Displaying 1 - 14 of 14
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guideline) | Sub Domain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C11661 | Edmonton Symptom Assessment System (ESAS) - appetite scale | ESASAppetiteScale | Scale rating appetite, as part of the Edmonton Symptom Assessment System (ESAS) | Scale rating appetite, as part of the Edmonton Symptom Assessment System (ESAS) | Appetite | 0;1;2;3;4;5;6;7;8;9;10 | Best appetite;;;;;;;;;;Worst possible appetite | Numeric Values |
Please circle the number that best describes: |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C11662 | Edmonton Symptom Assessment System (ESAS) - wellbeing scale | ESASWellbeingScale | Scale rating wellbeing, as part of the Edmonton Symptom Assessment System (ESAS) | Scale rating wellbeing, as part of the Edmonton Symptom Assessment System (ESAS) | Feeling of wellbeing | 0;1;2;3;4;5;6;7;8;9;10 | Best feeling of wellbeing;;;;;;;;;;Worst possible feeling of wellbeing | Numeric Values |
Please circle the number that best describes: |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C11663 | Edmonton Symptom Assessment System (ESAS) - breath shortness scale | ESASBreathShortnessScale | Scale rating the intensity of shortness of breath, as part of the Edmonton Symptom Assessment System (ESAS) | Scale rating the intensity of shortness of breath, as part of the Edmonton Symptom Assessment System (ESAS) | Shortness of breath | 0;1;2;3;4;5;6;7;8;9;10 | No shortness of breath;;;;;;;;;;Worst possible shortness of breath | Numeric Values |
Please circle the number that best describes: |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C11664 | Edmonton Symptom Assessment System (ESAS) - other problems scale | ESASOtherProblemScale | Scale rating the intensity of other problems, as part of the Edmonton Symptom Assessment System (ESAS) | Scale rating the intensity of other problems, as part of the Edmonton Symptom Assessment System (ESAS) | Other problem | 0;1;2;3;4;5;6;7;8;9;10 | Best or not present;1;2;3;4;5;6;7;8;9;Worst | Numeric Values |
Please circle the number that best describes: |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C11665 | Edmonton Symptom Assessment System (ESAS) - anatomic site | ESASAnatomicSite | Anatomic sites that hurt to be marked on diagrams of the front and the back of the body, as part of the Edmonton Symptom Assessment System (ESAS) | Anatomic sites that hurt to be marked on diagrams of the front and the back of the body, as part of the Edmonton Symptom Assessment System (ESAS) | Please mark on these pictures where it is you hurt | Alphanumeric |
Refer to picture on form |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points | 255 |
Free-Form Entry |
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| C11655 | Edmonton Symptom Assessment System (ESAS) - pain scale | ESASPainScale | Scale rating the intensity of pain, as part of the Edmonton Symptom Assessment System (ESAS) | Scale rating the intensity of pain, as part of the Edmonton Symptom Assessment System (ESAS) | Pain | 0;1;2;3;4;5;6;7;8;9;10 | No Pain;;;;;;;;;;Worst possible pain | Numeric Values |
Please circle the number that best describes: |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C17777 | Edmonton Symptom Assessment System (ESAS) - form complete date and time | ESASFormCompleteDateTime | Date and time the assessment was done, as part of the Edmonton Symptom Assessment System (ESAS) | Date the assessment was done, as part of the Edmonton Symptom Assessment System (ESAS) | Date Time | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points |
Free-Form Entry |
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| C11656 | Edmonton Symptom Assessment System (ESAS) - tiredness scale | ESASTirednessScale | Scale rating the intensity of tiredness, as part of the Edmonton Symptom Assessment System (ESAS) | Scale rating the intensity of tiredness, as part of the Edmonton Symptom Assessment System (ESAS) | Tiredness | 0;1;2;3;4;5;6;7;8;9;10 | Not tired;;;;;;;;;;Worst possible tiredness | Numeric Values |
Please circle the number that best describes: |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C17779 | Edmonton Symptom Assessment System (ESAS) - patient name | ESASPatientName | Name of patient taking the assessment. Edmonton Symptom Assessment System (ESAS) | Name of patient taking the assessment. Edmonton Symptom Assessment System (ESAS) | Patient's name | Alphanumeric | Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points | 255 |
Free-Form Entry |
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| C11657 | Edmonton Symptom Assessment System (ESAS) - nausea scale | ESASNauseaScale | Scale rating the intensity of nausea, as part of the Edmonton Symptom Assessment System (ESAS) | Scale rating the intensity of nausea, as part of the Edmonton Symptom Assessment System (ESAS) | Nausea | 0;1;2;3;4;5;6;7;8;9;10 | Not nauseated;;;;;;;;;;Worst possible nausea | Numeric Values |
Please circle the number that best describes: |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C17780 | Edmonton Symptom Assessment System (ESAS) - person completing form occupation name | ESASPrsnComplFrmOccupatnName | Name of occupation of the person completing the form, as part of the Edmonton Symptom Assessment System (ESAS) | Name of occupation of the person completing the form, as part of the Edmonton Symptom Assessment System (ESAS) | Complete by | Alphanumeric | Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points | 255 |
Free-Form Entry |
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| C11658 | Edmonton Symptom Assessment System (ESAS) - depression scale | ESASDepressionScale | Scale rating the intensity of depression, as part of the Edmonton Symptom Assessment System (ESAS) | Scale rating the intensity of depression, as part of the Edmonton Symptom Assessment System (ESAS) | Depression | 0;1;2;3;4;5;6;7;8;9;10 | Not depressed;;;;;;;;;;Worst possible depression | Numeric Values |
Please circle the number that best describes: |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C11659 | Edmonton Symptom Assessment System (ESAS) - anxiety scale | ESASAnxietyScale | Scale rating the intensity of anxiety, as part of the Edmonton Symptom Assessment System (ESAS) | Scale rating the intensity of anxiety, as part of the Edmonton Symptom Assessment System (ESAS) | Anxiety | 0;1;2;3;4;5;6;7;8;9;10 | Not anxious;;;;;;;;;;Worst possible anxiety | Numeric Values |
Please circle the number that best describes: |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C11660 | Edmonton Symptom Assessment System (ESAS) - drowsiness scale | ESASDrowsinessScale | Scale rating the intensity of drowsiness, as part of the Edmonton Symptom Assessment System (ESAS) | Scale rating the intensity of drowsiness, as part of the Edmonton Symptom Assessment System (ESAS) | Drowsiness | 0;1;2;3;4;5;6;7;8;9;10 | Not drowsy;;;;;;;;;;Worst possible drowsiness | Numeric Values |
Please circle the number that best describes: |
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J. Palliat Care 1991; 7(2):6-9. | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Edmonton Symptom Assessment System (ESAS) | Functional Outcomes | Outcomes and End Points |
Single Pre-Defined Value Selected |
