The relief of symptoms, whether they are physical, psychological, social or existential, or whether the symptom relief promotes well-being, is very important in the care of people who are severely ill or at the end of life. The development of patient-reported outcome measures (PROM) in palliative care is particularly challenging, as patients often suffer from multiple symptoms and are easily fatigued. Great effort is made to develop short and effective measures to meet this challenge. The Edmonton Symptom Assessment System (ESAS) includes numeric rating scales, ranging from 0 to 10, for the assessment of nine symptoms common in patients affected by an advanced cancer, and with the option of adding a possible tenth patient-specific symptom [1]. The instrument is also widely used as a PROM among patients affected by non-malignant diseases in palliative care, and is used in both scientific studies and in clinical practice [2]. ESAS was first translated into Swedish in 1997/1998 (personal communication Prof. Strang, 2015) and has been used in research [3] and in clinical practice. However, there is no official Swedish translation of ESAS available on the developer’s website (http://www.palliative.org/), and several different versions exist in the country, nonetheless, its use is recommended by Swedish national regulatory documents [4,5] and in both local and national guidelines for palliative care. ESAS was revised to the ESAS-r scale in 2011 [6], due to identified concerns about potentially confusing items, and the possibility of unintentionally reversing the scores of some items. Therefore, we decided to translate, culturally adapt and evaluate ESAS-r for use among patients and health care professionals in Sweden.