The patient needs assessment in cancer care: identifying barriers and facilitators to implementation in the UK and Canada

Abstract

Purpose Personalised information and support can be provided to cancer survivors using a structured approach. Needs assessment tools such as the Holistic Needs Assessment (HNA) in the UK and the Comprehensive Problem and Symptom Screening (COMPASS) questionnaire in Canada are recommended for use in practice; however, they are not widely embedded into practice. The study aimed to determine the extent to which nurses working in cancer care in the UK and Manitoba value NA and identify any barriers and facilitators they experience. Method Oncology nurses involved in the care of cancer patients in the UK (n = 110) and Manitoba (n = 221) were emailed a link to an online survey by lead cancer nurses in the participating institutions. A snowball technique was used to increase participation across the UK resulting in 306 oncology nurses completing the survey in the UK and 116 in Canada. Results Participants expressed concerns that these assessments were becoming bureaucratic “tick-box exercises” which did not meet patients’ needs. Barriers to completion were time, staff shortages, lack of confidence, privacy, and resources. Facilitators were privacy for confidential discussions, training, confidence in knowledge and skills, and referral to resources. Conclusion Many busy oncology nurses completed this survey demonstrating the importance they attach to HNAs and COMPASS. The challenges faced with implementing these assessments into everyday practice require training, time, support services, and an appropriate environment. It is vital that the HNA and COMPASS are conducted at optimum times for patients to fully utilise time and resources.

Age‐stratified distress thermometers with Worry and Learning problem domains for the paediatric oncology population: Development and validation

“…When reviewing the results of our ROC analyses, a cut-off of 4 allowed us to achieve as high a sensitivity value as possible whilst also aiming to get as close to a specificity value of 70%, which established literature suggests is retained for validity. 19 An exception to this would be the parental report for the Learning Thermometer, where a cut-off as high as seven could be chosen which may reduce false positives. However, a cut-off of four works well across all tools and for simplicity in busy clinical settings we suggest retaining this.…”

“…Using the NCCN recommended cut‐off of four, 4 both Thermometers had good sensitivity and specificity against validated measures across all age groups. When reviewing the results of our ROC analyses, a cut‐off of 4 allowed us to achieve as high a sensitivity value as possible whilst also aiming to get as close to a specificity value of 70%, which established literature suggests is retained for validity 19 . An exception to this would be the parental report for the Learning Thermometer, where a cut‐off as high as seven could be chosen which may reduce false positives.…”

“…Despite the benefits of screening, it should also be noted that without appropriate implementation, such as ensuring staff have enough time to complete the measures, completion rates can be poor and the measures reduced to "tick box" exercises. 19 When staff are able to view the HNA as beneficial for their practice, it tends to lead to better communication with patients and recognition of distress. 17 The crucial need for a short, valid, screening tool has therefore been established and has led to the development of these age-stratified screening tools for the paediatric and young adult oncology populations.…”

“…Distress screening is recommended to take part at regular timepoints in the care pathway, including diagnosis, end of treatment and entry into palliative care. Despite the benefits of screening, it should also be noted that without appropriate implementation, such as ensuring staff have enough time to complete the measures, completion rates can be poor and the measures reduced to “tick box” exercises 19 . When staff are able to view the HNA as beneficial for their practice, it tends to lead to better communication with patients and recognition of distress 17 …”

What is the evidence behind cancer care reviews, a primary care cancer support tool? A scoping review

“…For nurse-led cancer care assessments or holistic needs assessments (HNAs), survey data from the UK [ 36 , 37 ], Australia [ 38 ] and Canada [ 37 ] identified similar barriers to implementation, to those encountered for CCRs, with the biggest barriers being insufficient time and healthcare professionals to carry out assessments. Other barriers included lack of services to which patients could be referred to including those that were culturally sensitive, inadequate professional training and a lack of space to ask intimate questions.…”