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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
2004), to providing good-quality health care overall, and to improving health-related quality of life (Wen and Gustafson, 2004). The United Kingdom’s National Institute for Clinical Evidence recommends, for example, that “assessment and discussion of patients’ needs for physical, psychological, social, spiritual, and financial support should be undertaken at key points (such as at diagnosis; at commencement, during, and at the end of treatment; at relapse; and when death is approaching)” (NICE, 2004:7). Needs assessments are theorized to facilitate communication between patients and providers about issues that are not otherwise raised (Wen and Gustafson, 2004).
A systematic review of randomized trials (Gilbody et al., 2002) and one cancer-specific randomized pilot project (Boyes et al., 2006) addressing needs assessment used by itself or with minimal follow-up (such as feedback of results to clinicians) found little support for the effectiveness of the process in improving psychosocial functioning. When combined with follow-up care planning and implementation of those plans, however, needs assessment was found to be effective in improving access to needed services in a systematic review of randomized controlled trials evaluating the effectiveness of interventions in improving access to services after hospital discharge11 (Richards and Coast, 2003). In another systematic review and meta-analysis, systematic assessment of medical, functional, psychosocial, and environmental domains and follow-up implementation of an intervention plan were found to be effective in preventing functional decline in older adults (Stuck et al., 2002). Needs assessment was also identified as one essential ingredient in reduced hospital admissions or medical costs in a qualitative analysis of effective care coordination programs for Medicare (Chen et al., 2000). These findings are consistent with that of the committee that a combination of activities, rather than a single activity by itself (in this case, needs assessment), is needed for the effective delivery of appropriate psychosocial health care.
A systematic search by Wen and Gustafson (2004) for needs assessment instruments for patients with cancer revealed 17 patient and 7 family instruments (generally self-report) for which information was available on their reliability, validity, burden, and psychometric properties (see Table 4-2). These instruments varied greatly in the needs addressed,12 the domains
However, this review also found only “limited support” for the effectiveness of needs assessment when implementation of the recommended services was the responsibility of different providers.
For example: physical, psychological, and medical interactions; sexual problems; coping information; activities of daily living; interpersonal communication; availability and continuity of care; physician competence; support networks; spiritual needs; child care; family needs; pain/symptom control; home services; and having a purpose.