A cluster randomised trial of a Needs Assessment Tool for adult Cancer patients and their carers (NAT-C) in primary care: A feasibility study

Abstract

Background People with cancer often have unidentified symptoms and social care needs. The Needs Assessment Tool-Cancer (NAT-C) is a validated, structured method of assessing patient/carer concerns and prompting action, to address unmet need. Aims Assess feasibility and acceptability of a definitive two-armed cluster randomised trial of NAT-C in primary care by evaluating: recruitment of GP practices, patients and carers; most effective approach of ensuring NAT-C appointments, acceptability of study measures and follow-up. Methods Non-blinded, feasibility study in four General Practices, with cluster randomisation to method of NAT-C appointment delivery, and process evaluation. Adults with active cancer were invited to participate with or without carer. Practices cluster randomised (1:1) to Arm I: promotion and use of NAT-C with a NAT-C trained clinician or Arm II: clinician of choice irrespective of training status. Participants completed study questionnaires at: baseline, 1, 3 and 6 months. Patients booked a 20 minute needs-assessment appointment post-baseline. Patients, carers and GP practice staff views regarding the study sought through interviews/focus groups. Quantitative data were analysed descriptively. Qualitative data were analysed thematically, informed by Normalisation Process Theory. Progression to a definitive trial was assessed against feasibility outcomes, relating to: recruitment rate, uptake and delivery of the NAT-C, data collection and quality. Results Five GP practices approached, four recruited and trained to use the NAT-C. Forty-seven participants and 17 carers recruited. At baseline, 34/47 (72%) participants reported at least one moderate-severe unmet need, confirming study rationale. 32/47 (68%) participants received a NAT-C-guided consultation, 19 of which on Arm I. Study attrition at one month (n = 44 (94%), n = 16 (94%)), three months (n = 38 (81%), n = 14 (82%)) and six months (n = 32 (68%), n = 10 (59%)). Fifteen patient interviews conducted across the whole study and one focus group at each GP practice. Participants supported a definitive study and found measures acceptable. Conclusion The feasibility trial indicated that recruitment rate, intervention uptake and data collection were appropriate, with refinements, for a definitive multi-centre cluster randomised controlled trial. Feasibility outcomes informed the design of a 2-armed cluster randomised controlled trial to test the effectiveness and cost-effectiveness of the NAT-C compared with usual care.

Parkinson’s disease – palliative care needs assessment tool: adaptation and psychometric testing

“…Published experience of related tools supports the potential of the NAT:Parkinson’s disease. The NAT:PD-C, which had similar psychometric properties, reduces unmet palliative care need,15 without increasing consultation time in the oncology clinic,14 and taking a ‘double appointment’ in primary care (between 15 and 20 min) 33. Feasibility of use in everyday practice and completion time are important factors for future study, as is performance when embedded in established teams.…”

Concurrent Validity and Prognostic Utility of the Needs Assessment Tool: Progressive Disease Heart Failure

“…Predicting who has significant concerns now, addresses (i) the issue of helping people with advanced disease live as well as they can for as long as they can by providing timely, good palliation alongside continuing disease-directed treatment as necessary and (ii) helps form the context within which to judge the appropriate nature of any disease-directed treatment. Although published reports do not support common concerns about the needs measure being time-consuming (the NAT:PD-C was shown not to increase the length of an oncology clinic consultation (32), and to take 15-20 minutes only on average in primary care (38)), implementation of needs assessment requires training, attention to resources, and support from the specialist palliative care team.…”

“…(28,32) This is consistent with the literature showing patient benefits from clinicianadministered comprehensive geriatric assessment (35) and clinician-administered cancer needs assessments. (32,36,37,38) Predicting when the patient may die -possible at the population level, but very difficult at the individual -, only addresses the issue of care of the dying. Predicting who has significant concerns now, addresses (i) the issue of helping people with advanced disease live as well as they can for as long as they can by providing timely, good palliation alongside continuing disease-directed treatment as necessary and (ii) helps form the context within which to judge the appropriate nature of any disease-directed treatment.…”

Development of a tool for palliative care needs assessment and intervention: mixed methods research at a Swiss tertiary oncology clinic

“…Twenty-three individuals (16 physicians, four nurses, one psychologist, and two other professions) responded to the first survey. In the second round, a total of 50 people responded: 37…”