Proactive and systematic multidimensional needs assessment in patients with advanced cancer approaching palliative care: a study protocol

Abstract

IntroductionThe benefits of palliative care rely on how healthcare professionals assess patients’ needs in the initial encounter/s; crucial to the design of a personalised therapeutic plan. However, there is currently no evidence-based guideline to perform this needs assessment. We aim to design and evaluate a proactive and systematic method for the needs assessment using quality guidelines for developing complex interventions. This will involve patients, their relatives and healthcare professionals in all phases of the study and its communication to offer clinical practice a reliable approach to address the palliative needs of patients.Methods and analysisTo design and assess the feasibility of an evidence-based, proactive and systematic Multidimensional needs Assessment in Palliative care (MAP) as a semistructured clinical interview guide for initial palliative care encounter/s in patients with advanced cancer. This is a two-phase multisite project conducted over 36 months between May 2019 and May 2022. Phase I includes a systematic review, discussions with stakeholders and Delphi consensus. The evidence gathered from phase I will be the basis for the initial versions of the MAP, then submitted to Delphi consensus to develop a preliminary guide of the MAP for the training of clinicians in the feasibility phase. Phase II is a mixed-methods multicenter feasibility study that will assess the MAP’s acceptability, participation, practicality, adaptation and implementation. A nested qualitative study will purposively sample a subset of participants to add preliminary clues about the benefits and barriers of the MAP. The evidence gathered from phase II will build a MAP user guide and educational programme for use in clinical practice.Ethics and disseminationEthical approval for this study has been granted by the university research ethics committee where the study will be carried out (approval reference MED-2018-10). Dissemination will be informed by the results obtained and communication will occur throughout.

Prevalence of dyspnoea and usage of opioids in managing dyspnoea in advanced cancer patients: a longitudinal observational multi-centre study from India

“…They also noticed that the process was less time-consuming, and that the unidimensional dyspnoea assessment measures using the 0–10 Likert scale were efficient for screening dyspnoea in busy outpatient settings. However, multidimensional assessments are preferred in specialised palliative care practice, which is essential for a better understanding of the factors contributing to the patient’s overall symptom experience [ 26 ]. The study results of this study were based upon the data obtained from the patients directly attending palliative medicine outpatient clinics over 1 year.…”

What defines the comprehensive assessment of needs in palliative care? An integrative systematic review

“…A guide for a semi-structured clinical interview for the comprehensive assessment of needs could offer a systematic approach that allows the patient to express all their needs while enhancing this meaningful initial encounter with professionals. 85 Yet in order to provide evidence-based practice there remains a need for further research including the views of patients and their families in the decision and design of what needs to assess in first palliative care encounters.…”

“…Future studies are needed to acknowledge the opinion of palliative care professionals regarding preferred assessment methods, as well as to explore the opinion of patients and families on their core needs in palliative care to build a better understanding of patients and greater consensus on how or whether they can be appropriately assigned to given domains. Finally, building a systematic comprehensive assessment to reduce variation and explore patients’ needs while building a therapeutic alliance, such as through a semi-structured interview 85 may be a worthwhile contribution to practitioners who prefer not to rely on tools in the clinical setting.…”

Palliative and prognostic approach in cancer patients identified in the multicentre NECesidades PALiativas 2 study in Argentina

“…It is estimated that 69%-82% of cancer deaths would benefit from PC, improving quality of life, patient and caregiver distress and even survival [27]. As a result, multiple calls have been for integrating PC into standard oncology care to achieve the best outcomes [28][29][30][31].…”