Facilitating needs-based care of people with progressive cancer: evaluation of a palliative care needs assessment intervention

Introduction: Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis. The aim of this research program was to develop and examine the feasibility and efficacy of an intervention involving the systematic utilisation of the Palliative Care Needs Assessment Guidelines and Needs Assessment Tool: Progressive Disease – Cancer (NAT: PD-C), as a strategy to facilitate needs based care within the context of the advanced cancer population. Methods: Two preliminary validation studies were conducted to examine the psychometric properties of the NAT: PD-C. A prospective, multi-site, multi-discipline study was also conducted with a cohort of people with cancer in which bi-monthly telephone interviews to assess perceived unmet needs, depression, anxiety, service utilisation, quality of life and satisfaction with care were completed. Participants’ health professionals were trained in the use of the Guidelines and NAT: PD-C and asked to complete a NAT: PD-C approximately monthly for each participant. Changes in outcomes were compared pre- and post-intervention. Results: The initial validation studies supported the NAT: PD-C’s clarity, content and concurrent validity, acceptability and inter-rater reliability. Systematic use of the Guidelines and NAT: PD-C was associated with a significant reduction in health system and information needs as well as patient care and support needs. The tool exhibited a high rate of completion and did not lengthen consultations in which it was completed in comparison with those in which it was not completed. It appears to be a highly efficient tool to assist clinicians to identify issues of concern, particularly in areas that are not routinely well addressed. Conclusion: The NAT: PD-C is a highly acceptable and efficient tool and the routine, systematic and regular use of the Guidelines and NAT: PD-C in a range of generalist and specialist care settings can facilitate the timely provision of needs based care, including palliative care. Support from those involved in the care of people with advanced cancer and decision makers in health policy is required to ensure the successful dissemination and implementation of the resources within clinical settings.