BACKGROUND: Ambulatory palliative care (PC) focuses on managing complex symptoms, yet assessment relies on recall during infrequent visits to manage daily fluctuating symptoms. We aimed to design a PC-anchored remote symptom assessment (RSA) tool with patients and clinicians.

METHODS: We used user-centered, Agile design to develop and iteratively refine EMA-PAL, a web-based RSA prototype. Patients and clinicians (N = 14) from an ambulatory PC clinic participated in staged prototype development and testing through focus groups and interviews.

RESULTS: EMA-PAL features patient- and provider-facing interfaces that visualize daily Edmonton Symptom Assessment System (ESAS) scores, highlight severe symptoms, and support shared review during visits. Participants endorsed EMA-PAL's potential to enhance communication and workflow efficiency and identified priorities for future development (medication tracking and workflow integration).

CONCLUSION: This exploratory pilot suggests that PC-anchored RSA tools such as EMA-PAL may help address gaps in symptom assessment and timelier and patient-centered symptom management in ambulatory PC.