X
GO

Needs Assessment

Key Messages

  • The ageing of the population and the increases in the prevalence of cancer and other chronic diseases that accompany ageing, are driving an increased need for palliative care services. [1]
  • For adults with dementia or at end-of-life, meeting their needs can improve their quality of life. [2-5] Best-practice suggests that conducting a formal needs assessment forms an important part of palliative care in all settings. [4]
  • Needs assessments can help to identify what patients and their families consider important and where they need help and support. [3-8]
  • Recognition of the individual needs of palliative care patients and their family members forms the basis of individualised care. [3-8]
  • There is very little literature on the topic of needs assessments in palliative care for older adults.

 

No Evidence Synthesis

due to the sparcity of the published evidence

Background

Quality palliative care assists a person with a life-limiting illness to live as well as possible until death. [4,9] For people with dementia or at end-of-life, meeting their needs can improve their quality of life. [2-5] Needs assessment allows the responsible clinician to identify the areas that patients and their families consider important, assess and understand the goals of care, and prepare the patient and family in how to access help and support as it is required. Recognition of the individual needs of palliative care patients and their family members forms the basis of individualised care. [3-8]

Anticipatory medical care is an important component of palliative care particularly home-based or community palliative care. When a person is identified as being in the last few weeks or months of life, the approach to their care is primarily palliative and will include appropriate planning and anticipation of future care needs. This may include “preferred place of care”, out of hours support, and anticipatory prescribing. [10-14] Anticipatory medical care focuses on the medical and health-related needs and differs slightly from needs assessment. More can be read in Care Coordination, Managing Crises and Syringe Drivers.
 

Evidence Summary

Older and/or frail adults have complex and changing needs and may require a range of services provided over an extended period. [8] Comprehensive multi-disciplinary geriatric assessment (CGA) can be used to plan appropriate and coordinated care relevant to identified needs. [8]

In Australia, and many other parts of the world, the demand for palliative care services is increasing due to the ageing of the population and the increase in the prevalence of cancer and other chronic diseases that accompany ageing. [1] People living with advanced cancer may need relevant and easy-to-understand information about anxiety, fatigue, pain management, and how to adapt to loss of functioning. [7]

Needs of carer may also need to be considered. You can find out more on the Family Carers pages.

Best-practice suggests that needs assessment forms an important part of palliative care in all settings. [4] Assessing and addressing psychosocial, spiritual and supportive care needs is an important component of comprehensive and holistic palliative care. [5,6] Evidence suggests that home-based palliative care often meets the physical needs of patients and their carers. [15] However, spiritual and psychosocial concerns are often inadequately addressed. [15] You can read about Spiritual Care as a distinct topic. 

Palliative Care Needs Assessment (Ireland, 2014) tool comprises questions related to four domains of well-being: physical, social and occupational, psychological, and spiritual. [4] A health professional competent in the conduct of the assessment can use this series of questions to identify needs (identified or anticipated) to plan care or to refer a client to specialist palliative care. [4] It is recommended that a needs assessment be conducted at diagnosis of a life-limiting condition, at times of significant change (significant decline or deterioration, or change in family/social support or in functional status), at the request of the family or at end-of-life. [4] This tool is not specific for older adults.

The EASY-care tool is a comprehensive geriatric assessment (CGA) designed for assessing the unmet health and social needs of older people living in the community. [16] There is strong evidence for the validity and acceptability of EASY-Care as a personal needs assessment. [16] The tool has good acceptability internationally yet evidence is limited for the tool’s reliability, for its use as a population-level needs assessment or as a diagnostic tool for frailty. [16]

A significant proportion of older people in developed countries will spend the last year of their life in poor health (co-morbid conditions and/or frailty) and perhaps in social isolation. [17] An increasing number of older adults needing palliative care will live alone and wish to remain at home. [17] Informal support networks, technical aides and needs-based services form part of the emerging research investigating ways to allow older people at end-of-life to be cared for and to die at home, with optimal quality of life and minimal hospitalisations. [17]

It is suggested that embedding palliative care expertise in a rural community can best meet the palliative care needs of adults in that setting. [18] This requires educational programs and community support, and can be assisted by telehealth. [18] Geographic distance and costs are commonly noted as barriers. [18]

A needs assessment can be a systematic method of identifying unmet health and healthcare needs of a population. [19] In determining priorities for addressing the identified needs, it considers what should be done, what can be done, and what can be afforded. [19] A national health needs assessment for palliative care has been published in New Zealand. [20,21] In Australia, a needs assessment guide has been published but it relates to general medical services and is not specific to palliative care. [19] Aged care is one of the six key priorities for targeted work. [19]
 

Quality Statement

The quality of the included papers is acceptable. There is very little literature on the topic of needs assessments in palliative care for older people. Several papers addressed needs assessment in palliative care for a general adult population. [3-7,15,17-21] Papers focussing on needs assessment for older adults were not specific to palliative care. [2,8,16] Other literature was included to give context to this topic. [1,9-14] Guidelines for needs assessment in palliative care were published in New Zealand. [20,21] 
 
Page created 08 February 2018

 

  • References

  • About PubMed Search

  1. Worldwide Hospice Palliative Care Alliance, World Health Organization. Global Atlas of Palliative Care at the End of Life. London: Worldwide Hospice Palliative Care Alliance, World Health Organization; 2014.
  2. Cadieux MA, Garcia LJ, Patrick J. Needs of people with dementia in long-term care: a systematic review. Am J Alzheimers Dis Other Demen. 2013 Dec;28(8):723-33. doi: 10.1177/1533317513500840. Epub 2013 Sep 4.
  3. Buzgova R, Kozakova R, Sikorova L, Zelenikova R, Jarosova D. Development and psychometric evaluation of patient needs assessment in palliative care (PNAP) instrument. Palliat Support Care. 2016 Apr;14(2):129-37. doi: 10.1017/S1478951515000061. Epub 2015 Apr 8.
  4. National Clinical Programme for Palliative Care. Palliative Care Needs Assessment Guidance (2.46 MB pdf). Ireland: National Clinical Programme for Palliative Care; 2014.
  5. Howell D, Mayo S, Currie S, Jones G, Boyle M, Hack T, et al. Psychosocial health care needs assessment of adult cancer patients: a consensus-based guideline. Support Care Cancer. 2012 Dec;20(12):3343-54. doi: 10.1007/s00520-012-1468-x. Epub 2012 May 13.
  6. Lunder U, Furlan M, Simonic A. Spiritual needs assessments and measurements. Curr Opin Support Palliat Care. 2011 Sep;5(3):273-8. doi: 10.1097/SPC.0b013e3283499b20.
  7. Moghaddam N, Coxon H, Nabarro S, Hardy B, Cox K. Unmet care needs in people living with advanced cancer: a systematic review. Support Care Cancer. 2016 Aug;24(8):3609-22. doi: 10.1007/s00520-016-3221-3. Epub 2016 Apr 30.
  8. Threapleton DE, Chung RY, Wong SYS, Wong E, Chau P, Woo J, et al. Integrated care for older populations and its implementation facilitators and barriers: A rapid scoping review. Int J Qual Health Care. 2017 Jun 1;29(3):327-334. doi: 10.1093/intqhc/mzx041.
  9. World Health Organization (WHO). WHO Definition of Palliative Care. 2018 [cited 2018 Feb 08].
  10. Australian Commission on Safety and Quality in Health Care (ACSQHC). National Consensus Statement; essential elements for safe and high quality end-of-life care. Sydney: ACSQHC; 2015.
  11. Gippsland Region Palliative Care Consortium Clinical Practice Group. Palliative Care Anticipatory Prescribing Guidelines (519kb pdf). Warragul (Vic); Gippsland Region Palliative Care Consortium; 2016.
  12. Guidelines and Audit Implementation Network (GAIN). Guidelines for Palliative and End of Life Care in Nursing Homes and Residential Care Homes (1.09MB pdf). Belfast: GAIN; 2013.
  13. Tait P, Morris B, To T. Core palliative medicines: Meeting the needs of non-complex community patients. Aust Fam Physician. 2014 Jan-Feb;43(1):29-32.
  14. Therapeutic Guidelines Limited. Therapeutic Guidelines: Palliative Care. Version 4. Melbourne: Therapeutic Guidelines Ltd, 2016.
  15. Ventura AD, Burney S, Brooker J, Fletcher J, Ricciardelli L. Home-based palliative care: a systematic literature review of the self-reported unmet needs of patients and carers. Palliat Med. 2014 May;28(5):391-402.
  16. Craig C, Chadborn N, Sands G, Tuomainen H, Gladman J. Systematic review of EASY-care needs assessment for community-dwelling older people. Age Ageing. 2015 Jul;44(4):559-65. doi: 10.1093/ageing/afv050. Epub 2015 Apr 24.
  17. Aoun SM, Breen LJ, Howting D. The support needs of terminally ill people living alone at home: a narrative review. Health Psychol Behav Med. 2014 Jan 1;2(1):951-969. Epub 2014 Sep 25.
  18. Bakitas MA, Elk R, Astin M, Ceronsky L, Clifford KN, Dionne-Odom JN, et al. Systematic Review of Palliative Care in the Rural Setting. Cancer Control. 2015 Oct;22(4):450-64.
  19. Department of Health. PHN Needs Assessment Guide. Canberra: Department of Health; 2015.
  20. Palliative Care Council of New Zealand. National Health Needs Assessment for Palliative Care. Phase 1 Report: Assessment of Palliative Care Need. Wellington, New Zealand: Cancer Control New Zealand; 2011.
  21. Palliative Care Council of New Zealand. National Health Needs Assessment for Palliative Care. Phase 2 Report: Palliative Care Capacity and Capability. Wellington, New Zealand: Cancer Control New Zealand; 2013.

Definition

A Needs assessment is:
"a systematic method of identifying unmet health and healthcare needs of a population and making changes to meet these unmet needs. It involves an epidemiological and qualitative approach to determining priorities which incorporates clinical and cost effectiveness and patients' perspectives. This approach must balance clinical, ethical, and economic considerations of need—that is, what should be done, what can be done, and what can be afforded." [19]

Searches

Final search

(needs assessment[majr] OR needs assessment*[tiab] OR (needs[ti] AND assessment*[ti]))