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Bonacchi A, Chiesi F, Marunic G, Campani C, Gitto S, Lau C, Tagliaferro C, Forte P, Tarocchi M, Marra F. Needs evaluation questionnaire for liver disease: a novel assessment of unmet needs in patients with chronic liver disease. Hepatol Commun 2023; 7:e0007. [PMID: 36706170 PMCID: PMC9988321 DOI: 10.1097/hc9.0000000000000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/05/2022] [Accepted: 09/17/2022] [Indexed: 01/29/2023] Open
Abstract
Patients with chronic liver disease face debilitating complications in their daily living and constantly report several types of unmet needs, but there is a paucity of validated questionnaires to assess these needs. In this study, we present the development of the Needs Evaluation Questionnaire for Liver Diseases (NEQ-LD) for the assessment of unmet needs in patients with chronic liver disease. Two hundred eighty-six outpatients with chronic liver diseases from a single tertiary referral center completed the NEQ-LD and related validity measures. Item response theory analyses were performed and demonstrated the strong psychometric properties of the questionnaire. Differential item functioning analyses showed that the scale functions equally across groups differing for age, sex, and presence of cirrhosis, suggesting the large applicability of the NEQ-LD for the assessment of unmet needs and between-group comparisons. Criterion validity measures provided evidence that unmet needs were positively associated with measures of depression and anxiety and negatively associated with measures of subjective well-being and physical and mental health. Unmet needs were expressed by a high percentage of patients, especially in the areas of information and dialogue with clinicians. One third of the sample reported material needs. Most of the items describing unmet needs were reported more frequently by patients with cirrhosis. Conclusion: We developed a reliable, valid, and largely employable instrument that can promote patient-centered care and facilitate support services in Hepatology.
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Affiliation(s)
- Andrea Bonacchi
- Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute—ISPRO, Florence, Italy
- Centro Studi e Ricerca Synthesis, Associazione Promozione Sociale Sul Sentiero, Florence, Italy
| | - Francesca Chiesi
- Department of Neuroscience, Psychology, Drug, and Child’s Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Georgia Marunic
- Department of Neuroscience, Psychology, Drug, and Child’s Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Chloe Lau
- Department of Psychology, Western University, London, Ontario, Canada
| | | | - Paolo Forte
- Clinical Gastroenterology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mirko Tarocchi
- Clinical Gastroenterology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Biomedical Sciences ‘Mario Serio,’ University of Florence, Florence, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Chong E, Crowe L, Mentor K, Pandanaboyana S, Sharp L. Systematic review of caregiver burden, unmet needs and quality-of-life among informal caregivers of patients with pancreatic cancer. Support Care Cancer 2023; 31:74. [PMID: 36544073 PMCID: PMC9771849 DOI: 10.1007/s00520-022-07468-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Informal caregivers play an important supportive care role for patients with cancer. This may be especially true for pancreatic cancer which is often diagnosed late, has a poor prognosis and is associated with a significant symptom burden. We systematically reviewed the evidence on caregiver burden, unmet needs and quality-of-life of informal caregivers to patients with pancreatic cancer. METHOD PubMed, Medline, CINAHL and Embase databases were systematically searched on 31 August 2021. Qualitative and quantitative data on informal caregivers' experiences were extracted and coded into themes of burden, unmet needs or quality-of-life with narrative synthesis of the data undertaken. RESULTS Nine studies (five qualitative, four quantitative), including 6023 informal caregivers, were included in the review. We categorised data into three key themes: caregiver burden, unmet needs and quality-of-life. Data on caregiver burden was organised into a single subtheme relating to symptom management as a source of burden. Data on unmet needs was organised into three subthemes need for: better clinical communication; support and briefings for caregivers; and help with navigating the health care system. Data on quality-of-life indicate large proportions of informal caregivers experience clinical levels of anxiety (33%) or depression (12%-32%). All five qualitative studies were graded as good quality; three quantitative studies were poor quality, and one was fair quality. CONCLUSION High-quality pancreatic cancer care should consider the impacts of informal caregiving. Prospective longitudinal studies examining multiple dimensions of caregiver burden, needs, and quality-of-life would be valuable at informing supportive care cancer delivery to pancreatic cancer informal caregivers.
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Affiliation(s)
- Eric Chong
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lisa Crowe
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle, UK
| | - Keno Mentor
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle, UK ,Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Tyne and Wear, Newcastle Upon Tyne, UK
| | - Sanjay Pandanaboyana
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle, UK ,Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Tyne and Wear, Newcastle Upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle, UK
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Gardener AC, Ewing G, Deaton C, Farquhar M. Understanding how the Support Needs Approach for Patients (SNAP) enables identification, expression and discussion of patient support needs: A qualitative study. Chronic Illn 2022; 18:911-926. [PMID: 34677104 PMCID: PMC9643812 DOI: 10.1177/17423953211047840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To identify whether and how the support needs approach for patients enables patients with chronic progressive conditions to identify, express and discuss their unmet support needs. METHODS Thirteen healthcare professionals trained in the Support Needs Approach for Patients (SNAP), recruited from three pilot sites in the East of England (across primary, community and secondary care) delivered SNAP to 56 patients with the exemplar condition chronic obstructive pulmonary disease over a 4-month period. Healthcare professionals participated in a mid-pilot semi-structured interview (pilot site representatives) and end-of pilot focus group (all healthcare professionals). Twenty patients who received SNAP were interviewed about their experiences (topic-guided). Transcripts analysed using a framework approach. RESULTS There were differences in how healthcare professionals delivered SNAP and how patients engaged with it; analysing the interaction of these identified a continuum of care (from person-centred to healthcare professional-led) which impacted patient identification and expression of need and resulting responses. When delivered as intended, SNAP operationalised person-centred care enabling patient-led identification, expression and discussion of support needs. DISCUSSION SNAP addresses the rhetoric within policy, good practice guidance and the person-centred care literature espousing the need to involve patients in identifying their needs and preferences by providing healthcare professionals with a mechanism for achieving holistic person-centred care in everyday practice.
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Affiliation(s)
- A Carole Gardener
- School of Health Sciences, 6106University of East Anglia, Norwich, UK
| | - Gail Ewing
- Centre for Family Research, 2152University of Cambridge, Cambridge, UK
| | - Christi Deaton
- Department of Public Health and Primary Care, 2152University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Morag Farquhar
- School of Health Sciences, 6106University of East Anglia, Norwich, UK
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Kinchin I, Edwards L, Adrion E, Chen Y, Ashour A, Leroi I, Brugulat‐Serrat A, Phillips J, Masterson F, Kochovska S. Care partner needs of people with neurodegenerative disorders: What are the needs, and how well do the current assessment tools capture these needs? A systematic meta-review. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5764. [PMID: 35665539 PMCID: PMC9328373 DOI: 10.1002/gps.5764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/12/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The burden on care partners, particularly once dementia emerges, is among the greatest of all caregiving groups. This meta-review aimed to (1) synthesis evidence on the self-reported needs of care partners supporting people living with neurodegenerative disorders; (2) compare the needs according to care partner and care recipient characteristics; and (3) determine the face validity of existing care partner needs assessment tools. METHODS We conducted a systematic review of reviews involving a thematic synthesis of care partner needs and differences in needs according to demographic and other characteristics. We then conducted a gap analysis by identifying the themes of needs from existing needs assessment tools specific to dementia and cross-matching them with the needs derived from the thematic synthesis. RESULTS Drawing on 17 published reviews, the identified range of needs fell into four key themes: (1) knowledge and information, (2) physical, social and emotional support, (3) care partner self-care, and (4) care recipient needs. Needs may differ according to disease trajectory, relationship to the care recipient, and the demographic characteristics of the care partner and recipient. The 'captured needs' range between 8% and 66% across all the included needs assessment tools. CONCLUSIONS Current tools do not fully or adequately capture the self-identified needs of care partners of people living with neurodegenerative disorders. Given the high burden on care partners, which has been further exacerbated by the COVID-19 (SARS CoV-2) pandemic, the needs assessment tools should align with the self-reported needs of care partners throughout the caregiving trajectory to better understand unmet needs and target supportive interventions.
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Affiliation(s)
- Irina Kinchin
- Centre for Health Policy and ManagementTrinity College DublinUniversity of DublinDublinIreland
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) CentreUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Layla Edwards
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) CentreUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Emily Adrion
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
- Global Health Policy Unit, Social PolicyUniversity of EdinburghEdinburghUK
| | - Yaohua Chen
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
- Univ.Lille, Inserm UMR‐S1172, Lille Neurosciences & Cognition, Degenerative and Vascular Cognitive DisordersDepartment of GeriatricsCHU Lille, LiCENDLilleFrance
| | - Aya Ashour
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
- Department of NeurologyAin Shams UniversityCairoEgypt
| | - Iracema Leroi
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
| | - Anna Brugulat‐Serrat
- Global Brain Health InstituteUniversity of Dublin/University of California San FranciscoDublinIreland
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- Hospital del Mar Medical Research Institute (IMIM)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
| | - Jane Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) CentreUniversity of Technology SydneyUltimoNew South WalesAustralia
- School of NursingQueensland University of TechnologyBrsibaneQueenslandAustralia
| | - Fiona Masterson
- Family Carers Ireland Research Advisory NetworkDublinIreland
| | - Slavica Kochovska
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
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Clark J, Copsey B, Wright-Hughes A, McNaught E, Bijsterveld P, McCormack T, Foy R, Wilkes S, Dickson JM, Meads D, Farrin A, Johnson M. Cancer patients' needs assessment in primary care: study protocol for a cluster randomised controlled trial (cRCT), economic evaluation and normalisation process theory evaluation of the needs assessment tool cancer (CANAssess). BMJ Open 2022; 12:e051394. [PMID: 35508352 PMCID: PMC9073401 DOI: 10.1136/bmjopen-2021-051394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Unmet needs in patients with cancer and their carers are common but poorly identified and addressed. The Needs Assessment Tool-Cancer (NAT-C) is a structured consultation guide to identify and triage patient and carer unmet needs. The NAT-C is validated, but its effectiveness in reducing unmet patient and carer needs in primary care is unknown. METHODS AND ANALYSIS Cluster randomised controlled trial with internal pilot and embedded process evaluation to test the clinical and cost effectiveness of the NAT-C in primary care for people with active cancer in reducing unmet patient and carer need, compared with usual care. We will recruit 1080 patients with active cancer (and carers if relevant) from 54 general practices in England.Participating practices will be randomised 1:1 to either deliver an NAT-guided clinical consultation plus usual care or to usual care alone. Consenting participants with active cancer and their carers (if nominated) will be asked to complete study questionnaires at baseline, 1 and 3 months for all, 6 months except for those recruited outside of the last 3 months of recruitment, and attend an NAT-C appointment if allocated to an intervention practice. An internal pilot will assess: site and participant recruitment, intervention uptake and follow-up rates. The primary outcome, the proportion of patients with an unmet need on the Supportive Care Needs Survey Short Form 34 at 3 months postregistration, will be analysed using a multilevel logistic regression. Mixed-methods process evaluation informed by Normalisation Process Theory will use quantitative survey and interview data from clinicians and key stakeholders in cancer care to develop an implementation strategy for nationwide rollout of the NAT-C if the intervention is cost-effective. ETHICS AND DISSEMINATION Ethical approval from London-Surrey REC (20/LO/0312). Results will be peer-reviewed, published and made available to research participants. TRIAL REGISTRATION NUMBER ISRCTN15497400.
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Affiliation(s)
- Joseph Clark
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Bethan Copsey
- Leeds Institute of Clinical Trials Research, University of Leeds Clinical Trials Research Unit, Leeds, UK
| | | | - Emma McNaught
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | | | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Scott Wilkes
- School of Pharmacy, University of Sunderland, Sunderland, UK
| | - Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
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Dogan E, Ozcelik H. Determine the Symptom Intensities, Performance and Hopelessness Levels of Advanced Lung Cancer Patients for the Palliative Care Approach. Am J Hosp Palliat Care 2022; 39:1325-1332. [PMID: 35234052 PMCID: PMC9527446 DOI: 10.1177/10499091211073528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This research was conducted descriptively to determine the symptom intensities, performance and hopelessness levels of advanced lung cancer patients for the palliative care approach. The research sample consisted of 130 patients with advanced lung cancer, who were selected from 600 lung cancer populations in thoracic surgery and intensive care, outpatient chemotherapy, oncology in a university hospital in Turkey. Ethics Committee permission and the patients' written consent was obtained. Study data were collected face to face between January 2020 and July 2020 using the Edmonton Symptom Assessment System, Karnofsky Performance and Beck Hopelessness Scale. The mean age of the patients was 62.68 ± 8.867, 72.3% were males, and 89.2% were not currently working. The most common symptom in the patients was found to be fatigue 5.46 ± 2.12, worsening in general health and well-being 5.69 ± 1.87, loss of appetite 5.40 ± 2.59, and total symptom score 47.17 ± 19.03. Feelings and expectations about the future 1.40 ± 1.66, loss of motivation 3.43 ± 2.41, hope 2.05 ± 1.75, and total score of hopelessness 7.41 ± 6.01. There was a positive correlation between the patients' hopelessness level and their symptom burden, and a negative correlation was found with Karnofsky performance (P < .05). A significant difference was found between the patients' age, months since diagnosis, gender, education and employment status, stage of the disease, presence of metastases and analgesic use, and hopelessness scores (P < .05). It was determined that the symptom burden of patients with advanced lung cancer increased and as their Karnofsky performance decreased, their hopelessness level further increased. Hopelessness scores are affected by the socio-demographic and disease variables of the patients.
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Affiliation(s)
- Esra Dogan
- Nigde Bor State Hospital Orthopedic Service, 598724Nigde Omer Halisdemir University Zubeyde Hanim School of Health, Nigde, Turkey
| | - Hanife Ozcelik
- Department of Internal Medicine, 52989Nigde Omer Halisdemir University, Nigde, Turkey
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McDowell L, Corry J, Ringash J, Rischin D. Quality of Life, Toxicity and Unmet Needs in Nasopharyngeal Cancer Survivors. Front Oncol 2020; 10:930. [PMID: 32596155 PMCID: PMC7303258 DOI: 10.3389/fonc.2020.00930] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022] Open
Abstract
Concerted research efforts over the last three decades have resulted in improved survival and outcomes for patients diagnosed with nasopharyngeal carcinoma (NPC). The evolution of radiotherapy techniques has facilitated improved dose delivery to target volumes while reducing dose to the surrounding normal tissue, improving both disease control and quality of life (QoL). In parallel, clinical trials focusing on determining the optimal systemic therapy to use in conjunction with radiotherapy have been largely successful, resulting in improved locoregional, and distant control. As a consequence, neoadjuvant chemotherapy (NACT) prior to definitive chemoradiotherapy has recently emerged as the preferred standard for patients with locally advanced NPC. Two of the major challenges in interpreting toxicity and QoL data from the published literature have been the reliance on: (1) clinician rather than patient reported outcomes; and (2) reporting statistical rather than clinical meaningful differences in measures. Despite the lower rates of toxicity that have been achieved with highly conformal radiotherapy techniques, survivors remain at moderate risk of persistent and long-lasting treatment effects, and the development of late radiation toxicities such as hearing loss, cranial neuropathies and cognitive impairment many years after successful treatment can herald a significant decline in QoL. Future approaches to reduce long-term toxicity will rely on: (1) identifying individual patients most likely to benefit from NACT; (2) development of response-adapted radiation strategies following NACT; and (3) anticipated further dose reductions to organs at risk with proton and particle therapy. With increasing numbers of survivors, many in the prime of their adult life, research to identify, and strategies to address the unmet needs of NPC survivors are required. This contemporary review will summarize our current knowledge of long-term toxicity, QoL and unmet needs of this survivorship group.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - June Corry
- GenesisCare Radiation Oncology, Division Radiation Oncology, St. Vincent's Hospital, Melbourne, VIC, Australia.,Department of Medicine St Vincent's, The University of Melbourne, Melbourne, VIC, Australia
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Abstract
OBJECTIVES Patient-identified need is key to delivering holistic, supportive, person-centred care, but we lack tools enabling patients to express what they need to manage life with a long-term condition. The Support Needs Approach for Patients (SNAP) tool was developed to enable patients with advanced chronic obstructive pulmonary disease (COPD) identify and express their unmet support needs to healthcare professionals (HCPs), but its validity is unknown. This study aimed to establish face, content and criterion validity of the SNAP tool. DESIGN Two-stage mixed-methods study involving patients with advanced COPD and their carers. Stage 1: Face and content validity assessed though focus groups involving patients and carers considering appropriateness, relevance and completeness of the SNAP tool. Data were analysed using conventional content analysis. Stage 2: Content and criterion validity assessed in a postal survey through patient self-completion of the SNAP tool and disease impact measures (Chronic Respiratory Questionnaire, COPD Assessment Test, and Hospital Anxiety and Depression Scale). Content validity assessed using summary statistics; criterion validity via correlations between tool items and impact measures. SETTINGS AND PARTICIPANTS Two hundred and forty patients and carers participated. Stage 1 patient and informal carer participants were recruited from two primary care practices and Stage 2 patients from 28 practices. Participating practices located in the East of England were recruited via the NIHR Clinical Research Network: Eastern. RESULTS Patients and carers found the tool patient-friendly and comprehensive, with potential clinical utility. No tool items were redundant. Clear correlations were found between tool items and the majority of items in the impact measures. CONCLUSIONS The SNAP tool has good face, content and criterion validity. It has potential to support the delivery of holistic, supportive, person-centred care by enabling patients to identify and express their unmet support needs to HCPs.
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Affiliation(s)
- A Carole Gardener
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Silvia Mendonca
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia (UEA), Norwich, UK
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9
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Shunmugasundaram C, Rutherford C, Butow PN, Sundaresan P, Dhillon HM. Content comparison of unmet needs self-report measures used in patients with head and neck cancer: A systematic review. Psychooncology 2019; 28:2295-2306. [PMID: 31654540 DOI: 10.1002/pon.5257] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Morbidity from head and neck cancers (HNCs) and their treatment are significant, given their proximity to anatomical sites impacting facial appearance and function. Assessing the needs of HNC patients throughout their cancer journey is critical to informing quality care and improving quality of life. We aimed to identify available unmet needs measures in the HNC setting and appraise their content and psychometric properties. METHODS We conducted a systematic search of five electronic databases (July 2007-July 2019) to identify studies of unmet needs in patients with HNC. In addition, three web-based patient-reported outcome measures (PROMs) databases were searched for unmet needs measures. Citations were screened for eligibility and identified measures reviewed for content coverage and psychometric properties. From identified measures and literature, a conceptual framework with 12 clinically relevant aspects of unmet needs was developed and used to assess the conceptual coverage of available unmet needs measures. RESULTS Literature search identified 273 records of which 28 studies assessing unmet needs in HNC cancer met eligibility criteria. Seven unmet needs measures were identified from retrieved studies and seven additional measures from PROM databases. Thus, 14 measures in total were reviewed. Content mapping revealed that three measures demonstrated excellent content validity (greater than 80% conceptual coverage): Patient Concerns Inventory (PCI), Needs Assessment for Advanced Cancer Patients (NA-ACP), and James Supportive Care Screening (JSCS). CONCLUSION We recommend PCI be used to measure unmet needs in the HNC setting considering the importance of content validity over quantitative psychometric properties.
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Affiliation(s)
- Chindhu Shunmugasundaram
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Camperdown, New South Wales, Australia
| | - Claudia Rutherford
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Camperdown, New South Wales, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Camperdown, New South Wales, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, North Parramatta, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Camperdown, New South Wales, Australia
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10
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Hammill K, Bye R, Cook C. Occupational engagement of people living with a life-limiting illness: Occupational therapists' perceptions. Aust Occup Ther J 2019; 66:145-153. [PMID: 30666645 DOI: 10.1111/1440-1630.12557] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Occupational therapists working in palliative care aim to enable clients living with a life-limiting illness to continue participating in meaningful activities for as long as possible. However, little is published about the occupations people living with a life-limiting illness wish to engage in, and how occupational therapists can best enable occupational engagement. Therefore, this study aimed to gain an in-depth understanding of occupational therapists' perceptions on clients' occupational engagement post-diagnosis of a life-limiting condition. METHODS Occupational therapists working in Australia with people with a life-limiting illness were recruited to participate in a national online survey over the period of a month. Recruitment used a purposive, snowball sampling technique, resulting in 144 survey responses. Data were analysed using modified grounded theory methods. RESULTS Findings revealed two interrelated categories and four subcategories. The first category, focusing on life is concerned with therapists' perceptions of how clients continue to focus on living post diagnosis and encompasses two subcategories: (i) prioritised engagement and (ii) altered engagement. The second category, preparing for death, centres on therapists' perceptions of what clients do to practically prepare for death and find closure as their illness progresses, and is comprised of the two subcategories: (i) practical preparation for death and (ii) "facilitating closure". CONCLUSION Therapists perceived that meaningful occupational engagement changes over time as occupational performance levels decrease and clients prepare for death.
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Affiliation(s)
- Kathrine Hammill
- School of Science & Health - Occupational Therapy, Western Sydney University, Penrith, New South Wales, Australia
| | - Rosalind Bye
- School of Science & Health - Occupational Therapy, Western Sydney University, Penrith, New South Wales, Australia
| | - Catherine Cook
- School of Science & Health - Occupational Therapy, Western Sydney University, Penrith, New South Wales, Australia
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11
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Garg R, Asthana S, Bhatia S, Dhoundiyal R, Labani SP, Bhatnagar S. Quality of life and needs of the Indian advanced cancer patients receiving palliative careAssessment of the quality of life, problems, and needs of the advanced cancer patient receiving palliative care. CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_61_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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12
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Gourdji I, Mcvey L, Purden M. A Quality end of Life from A Palliative Care Patient's Perspective. J Palliat Care 2018. [DOI: 10.1177/082585970902500105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study explored the meaning of quality of life (QOL) from the perspective of palliative care patients by examining their lived experiences and their perceptions of what contributes to their QOL. Ten in-patients — five women and five men — took part in in-depth, semi-structured interviews. When asked about their QOL, they spoke about three distinct aspects: the meaning of a quality life at this stage in their illness trajectory, the experience of living with the illness, and factors that contributed to their QOL. Patients’ approach to life, illness life, and ideal quality life were found to create a sphere of influence that shaped their end-of-life experience. At the heart of living a quality end of life for these patients was their ability to “do the things that I usually do,” “be helpful to others,” and “live in a caring environment,” The findings highlight the importance of understanding each of these factors: patients’ approach to life, illness life, and ideal quality of life, and what they mean to patients in order to tailor interventions to enhance their QOL.
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Affiliation(s)
- Iris Gourdji
- Sir Mortimer B. Davis-Jewish General Hospital and School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Lynne Mcvey
- Sir Mortimer B. Davis-Jewish General Hospital and School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Margaret Purden
- Sir Mortimer B. Davis-Jewish General Hospital and School of Nursing, McGill University, Montreal, Quebec, Canada
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Richards R, Kinnersley P, Brain K, McCutchan G, Staffurth J, Wood F. Use of Mobile Devices to Help Cancer Patients Meet Their Information Needs in Non-Inpatient Settings: Systematic Review. JMIR Mhealth Uhealth 2018; 6:e10026. [PMID: 30552082 PMCID: PMC6315262 DOI: 10.2196/10026] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/20/2018] [Accepted: 07/10/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The shift from inpatient to outpatient cancer care means that patients are now required to manage their condition at home, away from regular supervision by clinicians. Subsequently, research has consistently reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. To date, no systematic reviews have evaluated how mobile devices have been used specifically to help patients meet to their information needs. OBJECTIVE A systematic review was conducted to identify studies that describe the use of mobile interventions to enable patients with cancer meet their cancer-related information needs in non-inpatient settings, and to describe the effects and feasibility of these interventions. METHODS MEDLINE, Embase, and PsycINFO databases were searched up until January 2017. Search terms related to "mobile devices," "information needs," and "cancer" were used. There were no restrictions on study type in order to be as inclusive as possible. Study participants were patients with cancer undergoing treatment. Interventions had to be delivered by a mobile or handheld device, attempt to meet patients' cancer-related information needs, and be for use in non-inpatient settings. Critical Appraisal Skills Programme checklists were used to assess the methodological quality of included studies. A narrative synthesis was performed and findings were organized by common themes found across studies. RESULTS The initial search yielded 1020 results. We included 23 articles describing 20 studies. Interventions aimed to improve the monitoring and management of treatment-related symptoms (17/20, 85%), directly increase patients' knowledge related to their condition (2/20, 10%), and improve communication of symptoms to clinicians in consultations (1/20, 5%). Studies focused on adult (17/20; age range 24-87 years) and adolescent (3/20; age range 8-18 years) patients. Sample sizes ranged from 4-125, with 13 studies having 25 participants or fewer. Most studies were conducted in the United Kingdom (12/20, 52%) or United States (7/20, 30%). Of the 23 articles included, 12 were of medium quality, 9 of poor quality, and 2 of good quality. Overall, interventions were reported to be acceptable and perceived as useful and easy to use. Few technical problems were encountered. Adherence was generally consistent and high (periods ranged from 5 days to 6 months). However, there was considerable variation in use of intervention components within and between studies. Reported benefits of the interventions included improved symptom management, patient empowerment, and improved clinician-patient communication, although mixed findings were reported for patients' health-related quality of life and anxiety. CONCLUSIONS The current review highlighted that mobile interventions for patients with cancer are only meeting treatment or symptom-related information needs. There were no interventions designed to meet patients' full range of cancer-related information needs, from information on psychological support to how to manage finances during cancer, and the long-term effects of treatment. More comprehensive interventions are required for patients to meet their information needs when managing their condition in non-inpatient settings. Controlled evaluations are needed to further determine the effectiveness of these types of intervention.
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Affiliation(s)
- Rebecca Richards
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Paul Kinnersley
- Centre for Medical Education, Cardiff University, Cardiff, United Kingdom
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Grace McCutchan
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - John Staffurth
- Section of Oncology, Palliative Care Medicine, Cardiff University, Cardiff, United Kingdom
| | - Fiona Wood
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
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Unmet needs of Italian cancer patients in different stages of the disease and care process. TUMORI JOURNAL 2018; 104:285-291. [PMID: 28478643 DOI: 10.5301/tj.5000637] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Assessing patients' unmet supportive care needs is essential in order to prioritize areas of cancer care that require improvement. The aim of the present cross-sectional study was to compare the unmet needs of cancer patients in different stages of the disease and care process (diagnosis, treatments following diagnosis, follow-up and/or rehabilitation, relapse/recurrence, progression of the disease, and palliative care). METHODS The research focused on patients from 7 oncology units of the same geographic region (Tuscany, a region of central Italy) in the same period of time regardless of primary tumor site. A total of 752 patients filled in the Needs Evaluation Questionnaire and the Psychological Distress Inventory. RESULTS We observed high rates of cancer patients who expressed unmet needs, especially in the areas of information and relational and material needs. The multiple regression models showed a direct correlation between psychological distress and extent of unmet needs. Individual unmet needs had significantly different entities at diverse phases. CONCLUSIONS The present study confirmed the dynamic nature of needs of cancer patients, highlighting some critical aspects in different stages of the care process on which to concentrate attention and resources and suggesting the usefulness of periodic and repeated assessments of principal needs.
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Lambert S, Bellamy T, Girgis A. Routine assessment of unmet needs in individuals with advanced cancer and their caregivers: A qualitative study of the palliative care needs assessment tool (PC-NAT). J Psychosoc Oncol 2017; 36:82-96. [DOI: 10.1080/07347332.2017.1382645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sylvie Lambert
- McGill University Faculty of Medicine, Ingram School of Nursing, Montreal, Quebec, Canada
- St. Mary's Research Centre, Montreal, Quebec, Canada
- UNSW Medicine, South Western Sydney Clinical School, Psycho-oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Thomas Bellamy
- Hunter New England Local Health District, James Fletcher Hospital, Newcastle, Australia
| | - Afaf Girgis
- UNSW Medicine, South Western Sydney Clinical School, Psycho-oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Chiesi F, Bonacchi A, Primi C, Miccinesi G. Assessing unmet needs in patients with cancer: An investigation of differential item functioning of the Needs Evaluation Questionnaire across gender, age and phase of the disease. PLoS One 2017; 12:e0179765. [PMID: 28742867 PMCID: PMC5526559 DOI: 10.1371/journal.pone.0179765] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 06/02/2017] [Indexed: 11/25/2022] Open
Abstract
The Needs Evaluation Questionnaire (NEQ) is a self-administered instrument used in oncology clinical practice and research.
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Affiliation(s)
- Francesca Chiesi
- Department of Neuroscience, Psychology, Drug Research, and Child Health (NEUROFARBA) -Section of Psychology, University of Florence, Italy
- * E-mail:
| | | | - Caterina Primi
- Department of Neuroscience, Psychology, Drug Research, and Child Health (NEUROFARBA) -Section of Psychology, University of Florence, Italy
| | - Guido Miccinesi
- Cancer Research and Prevention–ISPO, Clinical and Descriptive Epidemiology Unit, Florence, Italy
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17
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Mansfield E, Boyes AW, Bryant J, Sanson-Fisher R. Quantifying the unmet needs of caregivers of people with dementia: a critical review of the quality of measures. Int J Geriatr Psychiatry 2017; 32:274-287. [PMID: 27981694 DOI: 10.1002/gps.4642] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/02/2016] [Accepted: 11/16/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The array of demanding tasks carried out by caregivers of people with dementia have significant negative impacts on their physical, mental and social well-being. Needs assessment allows individuals to indicate the extent to which their needs across different areas have or have not been met, allowing for estimations of the prevalence of needs and the extent to which help is required. This approach is extremely valuable in a clinical context, as it enables identification of the areas with which caregivers report a particular desire for help and allows targeting of support and resources to those who identify high levels of unmet needs. This systematic review aimed to critically examine the psychometric properties of measures that assess unmet needs of caregivers of people with dementia. METHODS Medline, Embase, PsycINFO and Cochrane electronic databases were searched between January 1990 and August 2015 for English-language publications describing the development or validation of measures assessing the unmet needs of adult caregivers of people with dementia. The psychometric properties of included measures were assessed against standard criteria for psychometric quality. RESULTS Four measures met the inclusion criteria. Only half of the indices of psychometric quality were tested across measures. Three measures had adequate internal consistency reliability, of which one also showed adequate test-retest reliability. Two measures reported adequate construct validity, while criterion validity was not assessed for any measure. CONCLUSIONS There is a clear need to develop a psychometrically rigorous instrument to identify the unmet needs of caregivers of people with dementia. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Elise Mansfield
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health and Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia
| | - Allison W Boyes
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health and Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health and Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health and Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia
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18
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Ajay S, Østbye T, Malhotra R. Caregiving-related needs of family caregivers of older Singaporeans. Australas J Ageing 2017; 36:E8-E13. [PMID: 28191735 DOI: 10.1111/ajag.12370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the extent and correlates of caregiving-related needs among family caregivers of Singaporeans aged 75+ with ≥1 activity of daily living limitations (care-recipients). METHODS National survey data of 1181 care-recipient/caregiver dyads were used. Caregiver's report (yes/no) of 16 needs was assessed. Care-recipient and caregiver correlates of each need were determined through logistic regression analysis. RESULTS Caregiving-related needs were expressed by 42.3% caregivers. The most commonly reported need was keeping care-recipient safe at home (24.5%). Needs concerned with caring for care-recipients were more frequent than those concerned with the caregiver's own needs. The most frequent correlate was care-recipient's extent of mood impairment (associated with 13 needs). CONCLUSION Caregivers should not neglect themselves when engaging in care provision. Families and service providers should explore whether reported lack of needs reflects limited awareness and/or under-reporting.
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Affiliation(s)
- Shweta Ajay
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Truls Østbye
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Rahul Malhotra
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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19
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Li L, Xue J, Li ZZ, Chen LZ. Development and Testing of a Reliable and Valid Patient-Needs Questionnaire for Breast Cancer Inpatients in China. J Clin Diagn Res 2016; 10:XC06-XC10. [PMID: 27891441 DOI: 10.7860/jcdr/2016/17907.8668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 07/08/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Breast cancer patients are demanding more active roles in their care, especially in the initial diagnosis and treatment stages. At present, there is no suitable patient questionnaire that appropriately incorporates Chinese language, habits, and cultural differences. AIM To develop and validate a patient-needs questionnaire for female breast cancer inpatients in China. MATERIALS AND METHODS The questionnaire structure was based on Maslow's model and a modern medical model. In the first step, a focus group was used to design 125 questions, of which 64 constituted the initial questionnaire for item screening with a group of 115 hospitalized patients with breast cancer. Items were included or excluded based on the evaluation of eight statistical analysis. Ultimately, 38 items were selected and validated. The reliability and validity of the 38-item questionnaire were determined in a cohort of 323 patients. RESULTS The scale was set up with the 38 selected items. The four primary areas were disease knowledge, medical environment, psychosocial parameters and sexual attitudes. Cronbach's coefficient was 0.959. The split-half reliability value was 0.935. Principal component factor analysis extracted four common factors. CONCLUSION Our new questionnaire, designed to assess the care needs of Chinese inpatients with breast cancer is reliable, sensitive, effective, independent and representative. It can be used in medical practice as a tool for a more complete assessment of patients' needs.
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Affiliation(s)
- Ling Li
- Associate Senior Technician, Records Office, Guangzhou First People's Hospital, Guangzhou Medical College , Guangzhou, Guangdong, China
| | - Jing Xue
- Attending Doctor, Department of Epidemiology and Biostatistics, School of Public Health, Central South University , 78 Xiangya Road, Changsha, Hunan, China
| | - Zhan-Zhan Li
- Attending Doctor, Department of Epidemiology and Biostatistics, School of Public Health, Central South University , 78 Xiangya Road, Changsha, Hunan, China
| | - Li-Zhang Chen
- Professor, Department of Epidemiology and Biostatistics, School of Public Health, Central South University , 78 Xiangya Road, Changsha, Hunan, China
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20
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Wei C, Nengliang Y, Yan W, Qiong F, Yuan C. The patient-provider discordance in patients' needs assessment: a qualitative study in breast cancer patients receiving oral chemotherapy. J Clin Nurs 2016; 26:125-132. [PMID: 27647758 DOI: 10.1111/jocn.13374] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the differing perspectives of patients and providers and their assessment of supportive care needs in breast cancer patients receiving oral chemotherapy. BACKGROUND The patient-provider concordance in patients' needs assessment is critical to the effective management of cancer. Self-administered oral chemotherapy greatly shifts responsibilities for side-effect monitoring, symptom management and dose adjustments from the provider to the patient. Home-based care plans will be central to the effective management of these patients. DESIGN A descriptive qualitative design was used. METHODS A purposive sample of nine breast cancer patients, four oncologists and four oncology nurses were recruited in Shanghai, China. Semi-structured and in-depth interviews were conducted to collect data. A qualitative content analysis aimed at finding manifest and latent meanings of data was applied to analyse the information. RESULTS Four themes of needs emerged from the interviews with patients and providers: information/knowledge, communication, social support and symptom management, but patients and providers only agreed on the assessment of symptom and side-effects management needs. Patients want more positive encouraging information from providers, but providers think patients need more information of efficacy and safety. Patients appreciate support from other peer patients with similar experiences, but providers think the support from families and friends are readily available to them. Patients discussed their spiritual needs, while oncologists see the need to improve patient adherence to medication. CONCLUSION Breast cancer patients differed from their providers in assessment of healthcare needs. Further investigation of the relationships between patient-provider discordance and patient outcomes may guide interventions to improve care for cancer patients receiving oral chemotherapy. RELEVANCE TO CLINICAL PRACTICE Oncology nurses should develop a holistic home-based care plan by exploring and integrating the discordance of needs assessment of both patients and health providers.
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Affiliation(s)
- Chunlan Wei
- School of Nursing, Second Military Medical University, Shanghai, China.,Tongji University School of Medicine, Shanghai, China
| | - Yao Nengliang
- College of Nursing, University of Virginia, Charlottesville, VA
| | - Wang Yan
- Department of Breast Cancer, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China
| | - Fang Qiong
- Comprehensive Breast Health Center, Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College, Shanghai, China
| | - Changrong Yuan
- School of Nursing, Second Military Medical University, Shanghai, China
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21
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Lin WC, Tsao CJ. Information needs of family caregivers of terminal cancer patients in Taiwan. Am J Hosp Palliat Care 2016; 21:438-44. [PMID: 15612235 DOI: 10.1177/104990910402100609] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous studies have indicated that when family caregivers are provided with enough of the right information their coping strategies in caring for terminal cancer patients are enhanced. In Taiwan, family caregivers are highly involved in their ill family member’s symptom management and must stay at the bedside to share the nursing and caregiving tasks in the palliative care unit. The cross-sectional survey described here used a structured questionnaire to identify six domains of information needed among family caregivers who stay in the palliative care units to prepare them to provide hospice homecare after discharge. The six domains for which family members needed specific information included the basic tenets of caregiving, the disease, the social welfare of the patient, psychosocial issues, palliative care, and spirituality/religion. This study indicated that information about the disease itself was of greatest importance, with the least importance attached to spiritual and religious information. Age, gender, educational level, and socioeconomic status (SES) of family caregivers were factors in how they viewed the importance of each domain. Situation-related variables, such as the extent of each caregiver’s role in decision making, duration of the patient’s disease, and the treatment the patient was undergoing were also related to how caregivers valued each type of information. Study results indicated that the education of caregivers in the palliative care unit should be individualized based on each patient’s condition and each family’s characteristics.
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Affiliation(s)
- Wei-chun Lin
- Institute of Behavioral Medicine, National Cheng Kung University, Tainan, Taiwan
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22
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O'Reilly M, Larkin P, Conroy M, Twomey F, Lucey M, Dunne C, Meagher DJ. The Impact of a Novel Tool for Comprehensive Assessment of Palliative Care (MPCAT) on Assessment Outcome at 6- and 12-Month Follow-Up. J Pain Symptom Manage 2016; 52:107-16. [PMID: 27233135 DOI: 10.1016/j.jpainsymman.2015.12.343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 12/07/2015] [Accepted: 12/24/2015] [Indexed: 11/28/2022]
Abstract
CONTEXT Assessment in palliative care settings should be focused, sensitive, specific, and effective to minimize discomfort to vulnerable and often highly morbid patients. This report describes the development of an admission assessment protocol for a Specialist Palliative Care Inpatient Unit and its implementation into clinical practice. OBJECTIVES The aim of this study was to develop and investigate the impact of the implementation of a Specialist Palliative Care admission assessment tool on documentation of key patient needs. METHODS The outcome of a systematic literature review was used to develop an admission assessment protocol (the intervention) in a Specialist Palliative Care Inpatient Unit. Mixed methods were used to facilitate a comprehensive evaluation pre- and post-intervention to test the effectiveness, feasibility, and acceptability of the intervention. RESULTS The documented evidence of pain assessment improved from a baseline rate of 71% to 100% post-intervention. This improvement was maintained 12 months post-introduction of the tool (P < 0.001). The documented evidence of screening for spiritual distress increased from a baseline rate of 23% to 70% at 6 months and to 82% at 12 months (P < 0.001). The number of referrals made in the first 24 hours after assessment increased post-intervention (physiotherapy, P = 0.001; occupational therapy, P = 0.001; social work, P = 0.005; pastoral care, P = 0.005); this was maintained at 12 months. Significantly, more clinicians (88%) agreed that palliative care domains were comprehensively assessed post-intervention in comparison with 59% pre-intervention (P = 0.01). CONCLUSION Introducing the Milford Palliative Care Assessment Tool was associated with significant improvement in assessment of multiple important aspects of patient need.
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Affiliation(s)
| | - Philip Larkin
- School of Nursing, Midwifery and Health Systems, University College Dublin, Limerick, Ireland
| | | | | | | | - Colum Dunne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - David J Meagher
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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23
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Zafar W, Hafeez H, Jamshed A, Shah MA, Quader A, Yusuf MA. Preferences regarding disclosure of prognosis and end-of-life care: A survey of cancer patients with advanced disease in a lower-middle-income country. Palliat Med 2016; 30:661-73. [PMID: 26769733 DOI: 10.1177/0269216315625810] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cancer patients' preferences regarding disclosure of prognosis and end-of-life care remain under-reported from low- and middle-income countries where cancer poses an increasing demand on scarce healthcare resources. A better knowledge of these preferences can help in achievement of shared treatment goals. AIM To survey preferences of adult cancer patients regarding disclosure of prognosis and end-of-life care DESIGN A multidimensional questionnaire was developed to survey consecutively sampled patients. A fifth of the participants completed a repeat survey 3 months later. SETTING/PARTICIPANTS Adult patients at a specialist cancer center in Pakistan. RESULTS In total, 520 patients were surveyed initially (participation rate 98.6%) and 100 completed the repeat survey. Three in five respondents wanted a healthcare provider to give them detailed information about their prognosis and life expectancy. Those who wanted information withheld were significantly more likely to be female, to have a lower socioeconomic status, or to have lung cancer. Only two in five patients agreed that they wanted to die at home and more than 90% wanted all possible care till end-of-life. Yet, a little over half also agreed that they did not wish to be placed on a ventilator. In rank ordering preferences about end-of-life, respondents ranked "religious wellbeing" as the highest and "avoiding inappropriate prolongation of dying" as the lowest of six options. CONCLUSION A majority of adult cancer patients surveyed in this study wanted a truthful disclosure about their disease prognosis and expressed a preference for hospital-based care at end-of-life. Healthcare providers should find ways to tailor prognostic information to patients' expressed information needs.
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Affiliation(s)
- Waleed Zafar
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Haroon Hafeez
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Arif Jamshed
- Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Mazhar Ali Shah
- Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Ainul Quader
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - M Aasim Yusuf
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
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Hartley G, Berger Z, Maynard L. The development and evaluation of a holistic needs assessment within children's palliative care. Int J Palliat Nurs 2016; 22:236-42. [DOI: 10.12968/ijpn.2016.22.5.236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Georgina Hartley
- Clinical Psychologist, East Anglia's Children's Hospices (EACH) Cambridge, UK
| | - Zoe Berger
- Clinical Psychologist, Great Ormond Street Hospital for Children NHS Foundation Trust
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Bonacchi A, Miccinesi G, Galli S, Primi C, Chiesi F, Lippi D, Muraca M, Toccafondi A. Use of the Needs Evaluation Questionnaire with cancer outpatients. Support Care Cancer 2016; 24:3507-15. [PMID: 27005464 DOI: 10.1007/s00520-016-3176-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/11/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The Needs Evaluation Questionnaire (NEQ) is a self-administered instrument with 23 dichotomous items that is used both in oncology clinical practice and in research. It was originally developed for use in setting of hospitalization. The aim of the present study was to assess the factor structure of the NEQ in an outpatient oncology sample and to compare the unmet needs of inpatients and outpatients in the Italian context. METHODS In 6 Italian oncology departments, 783 patients completed the NEQ. Patients included in the study had different primary tumor sites and were in different phases of the disease and care process. There were 195 inpatients and 588 outpatients total. RESULTS Confirmatory factor analysis (CFA) showed that, with outpatients, the NEQ retained the distribution of the items in five main areas previously described with inpatients. Cancer outpatients expressed high percentages of unmet needs primarily concerning "material needs" and "needs for psycho-emotional support." Our survey also suggested that, in addition to the 23 original items, four new items could be tested for specific use with outpatients. CONCLUSIONS Our findings highlight the importance of establishing routine assessment of unmet needs also in clinical oncology settings different from wards-such as day hospitals, ambulatory rehabilitation, or follow-up ambulatory care-where, at least in the Italian context, the rate of unmet needs is currently considerably high. The NEQ could be an effective tool for this assessment.
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Affiliation(s)
- A Bonacchi
- Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research and Prevention-ISPO, Florence, Italy. .,Centro Studi e Ricerca Synthesis, Florence, Italy.
| | - G Miccinesi
- Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research and Prevention-ISPO, Florence, Italy
| | - S Galli
- Department of Neuroscience, Psychology, Drug Research, and Child Health (NEUROFARBA)-Section of Psychology, University of Florence, Florence, Italy
| | - C Primi
- Department of Neuroscience, Psychology, Drug Research, and Child Health (NEUROFARBA)-Section of Psychology, University of Florence, Florence, Italy
| | - F Chiesi
- Department of Neuroscience, Psychology, Drug Research, and Child Health (NEUROFARBA)-Section of Psychology, University of Florence, Florence, Italy
| | - D Lippi
- Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - M Muraca
- Centro Riabilitazione Oncologica, Institute for Cancer Research and Prevention-ISPO, Florence, Italy
| | - A Toccafondi
- Centro Studi e Ricerca Synthesis, Florence, Italy
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Abstract
OBJECTIVE Identification of areas that family members consider important and in which they need help and support is one of the main goals of palliative care. Our research aimed to assess the psychometric properties of a Czech version of the Family Inventory of Needs (FIN). METHOD The group comprised 272 family members of terminally ill cancer patients at the University Hospital in Ostrava. Reliability was assessed by internal consistency (Cronbach's alpha), test-retest reliability, and correlation of both scales and items within the scales (item-total correlation). To verify construct validity, exploratory factor analysis and principal component analysis with a varimax rotation were utilized. RESULTS Using exploratory factor analysis, the following four factors (domains) were extracted: basic information, information on treatment and care, support, and comfort of the patient. Cronbach's α for the entire questionnaire was 0.924 on the importance scale and 0.912 for the satisfaction scale; for all domains, a value of α greater than 0.7 was ascertained. Test-retest reliability was also higher than 0.7 for all domains. On the satisfaction scale, a moderate correlation was confirmed between unmet needs in the domains basic information, support, and comfort of the patient, and the total score, and in selected quality-of-life domains. SIGNIFICANCE OF RESULTS The results of tests on the psychometric properties of the FIN questionnaire demonstrated at least satisfactory validity and reliability, and confirmed that it can be employed to assess the needs of palliative care patients in the Czech Republic.
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28
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Development and psychometric evaluation of patient needs assessment in palliative care (PNAP) instrument. Palliat Support Care 2015; 14:129-37. [PMID: 25851115 DOI: 10.1017/s1478951515000061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although assessment of palliative patients' needs is a key issue in palliative care, a suitable instrument for identification of such needs is not available in Central European countries. Our objectives were to produce an adequate tool for identifying the importance and satisfaction of palliative patients' needs and to verify its psychometric properties. METHOD The patient needs assessment in palliative care (PNAP) instrument was constructed based on a literature review and qualitative research (focus groups, n = 5). The psychometric properties of the questionnaire were verified by a cross-sectional study. The convergent validity of the questionnaire was determined by confirmatory factor analysis. Furthermore, internal consistency, test-retest reliability, and construct validity were also tested. The qualitative research group comprised 30 participants (27 experts in palliative care, 1 patient, and 2 family members). Psychometric properties were evaluated in a group of 349 hospital inpatients terminally ill with chronic disease or cancer and receiving palliative care. RESULTS Based on the qualitative data analysis, a questionnaire was constructed that contained 42 items grouped into 5 domains. When testing the psychometric properties of the questionnaire, a new model containing 40 items in 7 domains was produced. Cronbach's α for the entire PNAP questionnaire was 0.89 on the importance scale and 0.80 on the satisfaction scale. Test-retest reliability was higher than 0.7 for all domains in both scales. SIGNIFICANCE OF RESULTS The results of tests on the psychometric properties of the PNAP questionnaire showed at least satisfactory validity and reliability, and it can be employed to assess the needs of palliative care patients in Central European countries.
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Benoot C, Deschepper R, Saelaert M, Grypdonck M, Bilsen J. Informal support needs of cancer patients who are living alone: a qualitative insight. Psychooncology 2015; 24:1066-72. [PMID: 25676614 DOI: 10.1002/pon.3766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/17/2014] [Accepted: 12/30/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Staying independent is an important need for cancer patients living alone. Such patients might have specific informal support needs in order to stay independent. We want to explore which informal support patients living alone perceive as helpful along the cancer care continuum. METHODS A purposeful sample of 32 patients living alone and undergoing cancer treatment were interviewed, using a semi-structured interview guide. Seventeen of them were interviewed a second time, 8 months to 1 year later. Analysis was conducted using grounded theory techniques. RESULTS The informal support patients received was not experienced unconditionally positive. We found that an equilibrium was necessary between reducing the disadvantages of living alone while not endangering the advantages of living alone, resulting in a need for an equilibrium between distance and proximity with their informal network. The needed equilibrium was influenced by the patients' history of living alone, the perception of helpfulness of the informal network, the acuteness of side-effects and prognosis of the disease. We found that, as treatment progressed, patients tended to favor proximity and needed a greater share of the support to be provided by professionals. CONCLUSIONS Cancer patients living alone experience informal support as an ambiguous blessing. Such support has to be given in a fine balance in order to be perceived as helpful. Health care providers should educate the informal network of the patient about which support is helpful, and under what circumstances.
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Glare PA, Chow K. Validation of a Simple Screening Tool for Identifying Unmet Palliative Care Needs in Patients With Cancer. J Oncol Pract 2014; 11:e81-6. [PMID: 25392521 DOI: 10.1200/jop.2014.001487] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The National Comprehensive Cancer Network (NCCN) palliative care (PC) guideline recommends PC screening for all patients and provides criteria for identifying those in need of referral to a PC specialist. This two-step process has not yet been validated as accurately identifying patients in need. The aim of this study was to validate a simplified method for screening and referral based on the existing guideline criteria. METHODS An 11-item screening tool was created, with scores from 0 to 14. Content validity was assessed by a panel of local PC experts. Construct and criterion validities were evaluated using data obtained from a previous study of guideline-based screening and referral. RESULTS Content validity of the tool was high, with eight items rated as essential. Patients who were closer to death had significantly higher scores, indicating its construct validity. Scores were also higher in patients who were identified as needing a consult and in those who had worse pain and other symptoms, indicating its criterion validity. Using a score of ≥ 5 as the trigger, approximately one third of hospitalized patients in the previous study would have been referred to a PC specialist, twice as many as occurred when the attending oncologist relied on his or her clinical judgment. CONCLUSION The tool seems to be a valid method for identifying patients with cancer with complex PC needs who would benefit from a PC consult. Reliability testing, external validation, and demonstration of the utility of the tool as a decision aid all await confirmation.
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Affiliation(s)
- Paul A Glare
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kimberly Chow
- Memorial Sloan Kettering Cancer Center, New York, NY
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Prue G, Santin O, Porter S. Assessing the needs of informal caregivers to cancer survivors: a review of the instruments. Psychooncology 2014; 24:121-9. [PMID: 24930811 DOI: 10.1002/pon.3609] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cancer may impact negatively on an informal caregiver's health long after treatment has ended. This review identifies the self-report measures currently in use to measure caregivers need for support and determines their scientific soundness and clinical utility. METHOD A systematic electronic database search of Medline, CINAHL, PsychINFO, BNI ProQuest was conducted. The psychometric properties and clinical utility of needs assessment tools for caregivers of cancer survivors (excluding advanced disease) were extracted and summarised. RESULTS Seven cancer survivor caregiver needs assessment tools were identified. Data on instrument development was well reported, although variability was noted in their structure and content. The majority demonstrated some degree of reliability and validity; only two were evaluated for test-retest reliability (CaSPUN and SPUNS) with only the SPUNS showing a high degree of reliability over time. The Health Care Needs Survey (HCNS), Needs Assessment of Family Caregivers-Cancer (NAFC-C) and Cancer Caregiving Tasks Consequences and Needs Questionnaire (CaTCoN) have been validated at various stages of the cancer continuum. Minimal data was available on responsiveness. CONCLUSION All assessment tools identified require further psychometric analysis. For research purposes, the use of the SPUNS (with its acceptable test-retest reliability) appears most appropriate; although its length may be of concern for clinical use; therefore, the shorter SCNS-P&C is likely to be more suitable for use clinically. At present, the NAFC-C demonstrates a great potential in both the research and clinical environments; however, it requires further psychometric testing before it can be fully recommended. Further analysis is necessary on ideal response formats and the meaning of a total needs score.
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Affiliation(s)
- Gillian Prue
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
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Hall A, D’Este C, Tzelepis F, Sanson-Fisher R, Lynagh M. The Survivor Unmet Needs Survey (SUNS) for haematological cancer survivors: a cross-sectional study assessing the relevance and psychometric properties. BMC Health Serv Res 2014; 14:211. [PMID: 24886475 PMCID: PMC4026596 DOI: 10.1186/1472-6963-14-211] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 04/30/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Relevant and psychometrically sound needs assessment tools are necessary for accurate assessment of haematological cancer survivors unmet needs. No previous study has developed nor psychometrically evaluated a comprehensive needs assessment tool for use with population-based samples of haematological cancer survivors. This study aimed to assess the validity and reliability of the Survivor Unmet Needs Survey (SUNS) with haematological cancer survivors. METHODS The relevance, content and face validity of the SUNS to haematological cancer survivors was assessed using qualitative interviews. Psychometric evaluation was conducted using data collected from haematological cancer survivors, aged 18-80 years at recruitment and recruited from four Australian cancer registries. Construct, convergent and discriminant validity; internal reliability and floor and ceiling effects were assessed. A second survey was completed by a sub-sample of survivors recruited from two of the four registries to assess test-retest reliability. RESULTS Results from 17 qualitative interviews confirmed the relevance, face and content validity of the original items of the SUNS for use with haematological cancer survivors. Overall, 1,957 eligible haematological cancer survivors were contacted by the cancer registries. Of these 1,280 were sent a survey, and 715 returned a survey (37% of eligible survivors contacted and 56% of survivors sent a survey). A total of 529 survivors completed all 89 items of the SUNS and were included in the exploratory factor analysis. Exploratory factor analysis supported the original five-factor structure of the SUNS. Evidence for convergent validity was established, with all five domains of the SUNS illustrating a moderate positive correlation with all three subscales of the Depression Anxiety and Stress Scale (DASS-21). All Cronbach's alpha values were above 0.9 and all corrected item-total correlations were acceptable (>0.2). Criteria for discriminant validity was not met, with only 10 of the 15 (67%) a-priori hypotheses supported. Test-retest reliability was acceptable for 40 of the 89 items (45%) and for three of the five domains. Significant floor effects were evident for all five domains. CONCLUSIONS The SUNS demonstrates evidence for multiple features of validity and reliability as a measure of unmet needs for haematological cancer survivors. However, evidence supporting some psychometric properties was limited.
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Affiliation(s)
- Alix Hall
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology & Environment, Australian National University, Acton, Canberra, ACT, Australia
| | - Flora Tzelepis
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Marita Lynagh
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
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Bužgová R, Hajnová E, Sikorová L, Jarošová D. Association between unmet needs and quality of life in hospitalised cancer patients no longer receiving anti-cancer treatment. Eur J Cancer Care (Engl) 2014; 23:685-94. [PMID: 24450878 DOI: 10.1111/ecc.12181] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 11/26/2022]
Abstract
Assessing the quality of life and unmet needs of cancer patients is an integral part of palliative care. This cross-sectional study sought to determine whether there is an association between quality of life and unmet needs, anxiety and depression in cancer patients who are no longer receiving anti-cancer treatment. The sample consisted of 93 patients from the oncology department at the University Hospital in Ostrava for whom further cancer treatment had been terminated as ineffective in halting the progression of their cancer. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Patient Needs Assessment in Palliative Care (PNAP) questionnaire, and the Hospital Anxiety and Depression Scale (HADS) were used to collect data. The overall quality of life score was quite low at 46. Most unmet needs were defined in terms of physical, psychological or spiritual needs. Correlations were found between impaired quality of life and lower Karnofsky scores (r = 0.50); increased physical (r = 0.52), psychological (r = 0.44) and spiritual (r = 0.36) needs; and higher levels of anxiety (r = -0.30) and depression (r = -0.68). Effective management of patients' physical (pain, fatigue and depression), psychological and spiritual needs may improve their quality of life.
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Affiliation(s)
- R Bužgová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Abstract
PURPOSE Although improvements in perioperative care have decreased surgical morbidity after radical cystectomy for muscle invasive bladder cancer, treatment side effects still have a negative impact on patient quality of life. We examined unmet patient needs along the illness trajectory. MATERIALS AND METHODS A total of 30 patients (26.7% women) treated with cystectomy and urinary diversion for muscle invasive bladder cancer participated in the study. Patients were recruited from the Department of Urology at Mount Sinai and through advertisements on the Bladder Cancer Advocacy Network (BCAN) website between December 2011 and September 2012. Data were collected at individual interviews, which were audiotaped and transcribed. Transcribed data were quantitatively analyzed to explore key unmet needs. RESULTS At diagnosis unmet informational needs were predominant, consisting of insufficient discussion of certain topics, including urinary diversion options and their side effects, self-care, the recovery process and medical insurance. Unmet psychological needs related to depression, and worries about changes in body image and sexual function were reported. Postoperative unmet needs revolved around medical needs (eg pain and bowel dysfunction) and instrumental needs (eg need of support for stomal appliances, catheters and incontinence). During survivorship (ie 6 to 72 months postoperatively) unmet needs centered around psychological support (ie depression, poor body image and sexual dysfunction) and instrumental support (eg difficulty adjusting to changes in daily living). CONCLUSIONS Meeting patient needs is imperative to ensure adequate patient involvement in health care and enhance postoperative quality of life. An effective support provision plan should follow changes in patient needs.
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Patient-Reported Outcome Measures for the Identification of Supportive Care Needs in People With Lung Cancer. Cancer Nurs 2013; 36:E1-17. [DOI: 10.1097/ncc.0b013e31826f3c8f] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Brazil K, Kaasalainen S, Williams A, Dumont S. A comparison of support needs between rural and urban family caregivers providing palliative care. Am J Hosp Palliat Care 2013; 31:13-9. [PMID: 23345612 DOI: 10.1177/1049909112474712] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The present study examined the support needs for urban and rural family caregivers of a palliative family member using a cross-sectional telephone survey in northeastern Ontario, Canada (n = 140; 70 urban, 70 rural). Support needs identified as most important by both the groups were informational. Rural caregivers reported greater unmet needs in tangible support (P = .01). No differences were observed between the groups for emotional or informational support needs (P = .25 and P = .35, respectively). Rural and urban caregivers perceived care for care recipients as accessible (mean accessibility score 1.9, standard deviation [SD] = 0.09 and 1.7, SD = 0.7, respectively, P = .20); the majority indicated that when needed, services were easily and quickly obtained. Although there are similarities in the formal care experiences, rural caregivers experience greater unmet needs in receiving support for instrumental activities.
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Affiliation(s)
- Kevin Brazil
- 1School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
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Morrison V, Henderson BJ, Zinovieff F, Davies G, Cartmell R, Hall A, Gollins S. Common, important, and unmet needs of cancer outpatients. Eur J Oncol Nurs 2011; 16:115-23. [PMID: 21555246 DOI: 10.1016/j.ejon.2011.04.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 04/01/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To maximize patient well-being, health and social care should, whenever possible, address individual patient needs. The present study aims firstly, to identify prevalent, salient and unmet needs amongst cancer outpatients, and secondly, to explore socio-demographic and clinical influences on expressed need. METHODS One-hundred and ten outpatients registered at a UK cancer treatment centre completed a self-report questionnaire measuring the presence, salience and degree to which 80 need items were met. Six broad cancer sites were represented: urology, colorectal, breast, gynaecology, haematology, and head and neck. RESULTS The mean number of needs reported was 27. The top five needs concerned the treatment, care and health information patients receive from healthcare professionals, all of which were rated as well met. Least met needs included receiving genetic information, information about lifestyle changes, help with worries about spread or recurrence, and parking near treatment centres. Salient needs showed greater variation across the sample and were often unmet, for example the need for genetic information, and the need for information about symptoms/indicators of recurrence. Gender (female), age (younger), having an informal caregiver, and cancer site all affected aspects of need; whereas time since diagnosis and type of treatment did not. CONCLUSIONS Acknowledging these influences on patient need could help guide patient-centred support services with potential gains to patient satisfaction and well-being.
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Affiliation(s)
- V Morrison
- School of Psychology, Bangor University, Bangor, Gwynedd, LL57 2AS, UK.
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Shim EJ, Lee KS, Park JH, Park JH. Comprehensive needs assessment tool in cancer (CNAT): the development and validation. Support Care Cancer 2010; 19:1957-68. [DOI: 10.1007/s00520-010-1037-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 10/22/2010] [Indexed: 01/05/2023]
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Stajduhar K, Funk L, Toye C, Grande G, Aoun S, Todd C. Part 1: Home-based family caregiving at the end of life: a comprehensive review of published quantitative research (1998-2008). Palliat Med 2010; 24:573-93. [PMID: 20562171 DOI: 10.1177/0269216310371412] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The changing context of palliative care over the last decade highlights the importance of recent research on home-based family caregiving at the end of life. This article reports on a comprehensive review of quantitative research (1998-2008) in this area, utilizing a systematic approach targeting studies on family caregivers, home settings, and an identified palliative phase of care (n = 129). Methodological challenges were identified, including: small, non-random, convenience samples; reliance on descriptive and bivariate analyses; and a dearth of longitudinal research. Robust evidence regarding causal relationships between predictor variables and carer outcomes is lacking. Findings suggest the need for knowledge regarding: family caregiving for patients with non-malignant terminal conditions; whether needs and outcomes differ between family caregivers at the end of life and comparison groups; and caregiver outcomes in bereavement. Clear definitions of 'family caregiving', 'end of life', and 'needs' are required as well as greater application and testing of theoretical and conceptual explanations.
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Affiliation(s)
- Ki Stajduhar
- School of Nursing, University of Victoria, British Columbia, Canada, Centre on Aging, University of Victoria, British Columbia, Canada.
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Psychometric properties of cancer survivors’ unmet needs survey. Support Care Cancer 2010; 19:221-30. [DOI: 10.1007/s00520-009-0806-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 12/15/2009] [Indexed: 12/27/2022]
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Waller A, Girgis A, Lecathelinais C, Scott W, Foot L, Sibbritt D, Currow D. Validity, reliability and clinical feasibility of a Needs Assessment Tool for people with progressive cancer. Psychooncology 2009; 19:726-33. [DOI: 10.1002/pon.1624] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Campbell HS, Sanson-Fisher R, Taylor-Brown J, Hayward L, Wang XS, Turner D. The cancer Support Person's Unmet Needs Survey. Cancer 2009; 115:3351-9. [DOI: 10.1002/cncr.24386] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kim Y, Kashy DA, Spillers RL, Evans TV. Needs assessment of family caregivers of cancer survivors: three cohorts comparison. Psychooncology 2009; 19:573-82. [DOI: 10.1002/pon.1597] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Waller A, Girgis A, Currow D, Lecathelinais C. Development of the palliative care needs assessment tool (PC-NAT) for use by multi-disciplinary health professionals. Palliat Med 2008; 22:956-64. [PMID: 18952754 DOI: 10.1177/0269216308098797] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Needs assessment strategies can facilitate prioritisation of resources. To develop a needs assessment tool for use with advanced cancer patients and caregivers, to prompt early intervation. A convenience sample of 103 health professionals viewed three videotaped consultations involving a simulated patient, his/her caregiver and a health professional, completed the Palliative Care Needs Assessment Tool (PC-NAT) and provided feedback on clarity, content and acceptability of the PC-NAT. Face and content validity, acceptability and feasibility of the PC-NAT were confirmed. Kappa scores indicated adequate inter-rater reliability for the majority of domains; the patient spirituality domain and the caregiver physical and family and relationship domains had low reliability. The PC-NAT can be used by health professionals with a range of clinical expertise to identify individuals' needs, thereby enabling early intervention. Further psychometric testing and an evaluation to assess the impact of the systematic use of the PC-NAT on quality of life, unmet needs and service utilisation of patients and caregivers are underway.
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Affiliation(s)
- A Waller
- Centre for Health Research & Psycho-oncology, School of Medicine & Public Health, The Cancer Council NSW, University of Newcastle & Hunter Medical Research Institute, Newcastle, NSW, Australia.
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Osse BHP, Vernooij-Dassen MJFJ, Schadé E, Grol RPTM. A practical instrument to explore patients' needs in palliative care: the Problems and Needs in Palliative Care questionnaire short version. Palliat Med 2007; 21:391-9. [PMID: 17901098 DOI: 10.1177/0269216307078300] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Short and convenient checklists are necessary tools to support and structure needs assessments in daily palliative practice. This study aims to develop a short version of the Problems and Needs in Palliative Care questionnaire (PNPC-sv); a self-report questionnaire for patients covering all dimensions of palliative care, to investigate their problems and (unmet) needs. METHODS The original Problems and Needs in Palliative Care questionnaire (PNPC) instrument is a comprehensive checklist of problems and needs for palliative care, and has shown validity and reliability. With its 90 items, however, it is not always practical. Thus it was abridged to a short version with 33 items. The validity and reliability are established with its item response, its internal consistency, and with its correlations with the original PNPC and with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and COOP/WONCA quality-of-life measures. A secondary analysis was done with data from 94 patients with metastatic cancer who had completed the long version. RESULTS Each item in the PNPC represents a problem relevant to 25% of the patients or more. High correlations of PNPC-sv and PNPC domains demonstrate construct validity. The dimension reliability was satisfactory (Cronbach's alpha > 0.70), while two problem-aspect domains were less coherent. The PNPC-sv domains show convergent validity with corresponding health-related quality-of-life domains. CONCLUSION The PNPC-sv is a concise, patient-centred tool that helps to identify the problems affecting the patient's quality of life and needs for care. It identifies prevalent needs for care and appears reliable. Further research should study the clinical effects of integrating the questionnaire into daily palliative-care practice.
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Affiliation(s)
- Bart H P Osse
- Centre for Quality of Care Research (WOK) University Medical Centre St Radboud, Nijmegen, The Netherlands.
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Richardson A, Medina J, Brown V, Sitzia J. Patients' needs assessment in cancer care: a review of assessment tools. Support Care Cancer 2007; 15:1125-44. [PMID: 17235503 DOI: 10.1007/s00520-006-0205-8] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 11/30/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The assessment of patients' needs for care is a critical step in achieving patient-centred cancer care. Tools can be used to assess needs and inform care planning. This review discusses the importance of systematic assessment of needs in routine care and the contribution tools can make to this process. METHOD A rapid appraisal was undertaken to identify currently available tools for patient assessment in cancer care through searches conducted with Medline and CINHAL databases. It focused on tools for the systematic assessment of individual patients' needs for help, care or support, to be used for clinical purposes-not for research or other purposes. Tools that focused on a single domain of care such as psychosocial needs were excluded, as were studies of patient satisfaction. A wide list of search terms was used, with references stored and managed using bibliographic software. RESULTS In all, 1,803 papers were identified from the initial search, with 91 papers found to be relevant; although 36 tools were identified, only 15 tools were found to fit our criteria. These were appraised for their validity, reliability, responsiveness to change and feasibility, including acceptability to patients. The process of their development and psychometric properties were reasonably well documented, but data on how feasible they were to use in practice was scarce. Each tool met some but not all the widely accepted criteria for validity, reliability, responsiveness and burden. None were found to be complete for all dimensions of needs assessment. Most have not been sufficiently well tested for use in routine care. CONCLUSION There is a need to continue to develop and test tools that have the attributes necessary for effective practice and to research their effects on the quality of supportive cancer care.
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Affiliation(s)
- Alison Richardson
- Florence Nightingale School of Nursing and Midwifery, King's College London, 5th Floor Waterloo Bridge Wing, Franklin Wilkins Building, 150 Stamford Street, London, SE1 9NN, UK.
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Fridriksdottir N, Sigurdardottir V, Gunnarsdottir S. Important needs of families in acute and palliative care settings assessed with the family inventory of needs. Palliat Med 2006; 20:425-32. [PMID: 16875113 DOI: 10.1191/0269216306pm1148oa] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Family support has been recognized in the development of palliative care in Iceland, yet studies focusing on family needs are lacking. The aims of this study were to evaluate the perceived care needs of family members of patients receiving palliative care, to what extent these needs were met, and whether needs differed based on background characteristics and site of care. Family members of 111 patients from acute and palliative care settings agreed to participate, and 67 (60%) completed the study. The Family Inventory of Needs was used to quantify family needs and to what extent they were met. All 20 needs measured were considered important. The number of needs did not differ by site of palliative care. Overall, health care professionals met 67% of needs. Needs were more likely to be met in specialized palliative care settings than on acute units and the needs of spouses were more likely to be met than others.
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Affiliation(s)
- N Fridriksdottir
- Department of Oncology, Haematology and Palliative Care, Landspitali-University Hospital, Eiriksgata 19, 101 Reykjavik, Iceland.
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Hwang SS, Chang VT, Alejandro Y, Osenenko P, Davis C, Cogswell J, Srinivas S, Kasimis B. Caregiver unmet needs, burden, and satisfaction in symptomatic advanced cancer patients at a Veterans Affairs (VA) medical center. Palliat Support Care 2006; 1:319-29. [PMID: 16594221 DOI: 10.1017/s1478951503030475] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Caregiver outcomes among those caring for symptomatic advanced cancer patients at VA Medical Centers have not been well reported. The purposes of this study were (1) to identify the caregiver characteristics and their unmet needs; (2) to examine the association between caregiver unmet needs, caregiver burden, and caregiver satisfaction; and (3) to identify the independent predictors of different caregiver outcomes. METHODS One hundred caregivers completed three caregiver outcomes instruments: Family Inventory of Needs (FIN), Care Strain Index (CSI), and Family Satisfaction with Advanced Cancer Care (FAMCARE). The caregivers' demographics and their function, depression, health status, and social support status as well as the caregivers' perception of the patients' unmet needs (PPUN) were obtained. Principal component analysis was performed to examine the underlying dimensions of caregiver outcome measures. Pearson correlation and stepwise multivariate regression analyses were performed. RESULTS The median number of unmet needs was 2 and the median CSI score was 4. Most of unmet needs were related to information needs (needing more information related to home care, finding help with the problems at home, and disease prognosis) and symptom management. The majority of caregivers were satisfied or very satisfied by the care patients received. Spouse caregivers (N = 60, 60%) were significantly older (p = 0.006) with higher unemployment rates (p = 0.001), higher depression scores (p = 0.04), and lower social support scores (p < 0.0001) than nonspouse caregivers (N = 40, 40%). The PPUN predicted caregiver burden and the presence of caregiver unmet needs independently. The presence of caregiver unmet needs was the only independent predictor of caregiver satisfaction. Caregivers with a high PPUN and higher depression score experienced a higher burden. SIGNIFICANCE OF THE RESEARCH The caregiver outcome model is proposed and needs to be further validated in a new cohort of caregivers.
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Affiliation(s)
- Shirley S Hwang
- Section Hematology/Oncology (111), VA New Jersey Health Care System, East Orange 07018, USA.
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Bradley NM, Chow E, Tsao MN, Danjoux C, Barnes EA, Hayter C, Holden L, Yau V, Li K, Doyle M, Sinclair E. Reasons for Poor Accrual in Palliative Radiation Therapy Research Studies. ACTA ACUST UNITED AC 2006; 3:110-9. [DOI: 10.3816/sct.2006.n.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vernooij-Dassen MJFJ, Osse BHP, Schadé E, Grol RPTM. Patient autonomy problems in palliative care: systematic development and evaluation of a questionnaire. J Pain Symptom Manage 2005; 30:264-70. [PMID: 16183010 DOI: 10.1016/j.jpainsymman.2005.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2005] [Indexed: 11/29/2022]
Abstract
No instrument to assess autonomy problems in palliative care is currently available. The purpose of this study was to develop a comprehensive and concise questionnaire to measure autonomy problems in palliative cancer patients and to study its validity and reliability. We systematically developed a questionnaire through: a) a literature review of the concepts and elements of autonomy; b) qualitative analysis of interviews with patients and professional carers; c) the construction of questionnaires; and d) testing validity and reliability. The basic conceptual elements were: dependency, losing control, and limitation of activities. Patients with disseminated cancer in the palliative stage of the disease (n = 64) participated in the study. A 9-item Patient Autonomy Questionnaire (PAQ) was developed (Cronbach's alpha 0.86), followed by a concise 4-item version (PAQs) (Cronbach's alpha 0.71). Autonomy problems were more prevalent than pain problems. The development of the PAQ may help draw attention to autonomy problems.
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