Needs Assessment
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Needs Assessment

Key Messages

  • The assessment of needs forms part of the WHO definition of palliative care and the basis of individualised and holistic care. [1,2]
  • A needs assessment explores and identifies what a person and their family consider important to then assess and understand the goals of care and prepare them to access support as it is required. [1-8]
  • Most needs assessment tools have been developed and tested for oncology patients. [2]
  • The few needs assessment tools specific to the needs of older people are comprehensive geriatric assessments (CGAs) or specific to heart failure, chronic obstructive pulmonary disease (COPD) or carers of people with dementia. [2-11]
  • Further testing of existing needs assessment tools is needed to determine how useful and reliable they are in clinical practice. [2-6,8,10]

Background

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), after a hospital admission, at the request of the family or at the beginning of the terminal phase. [1] Needs assessment tools developed to assess palliative care have been mostly developed and tested for oncology patients with fewer tools for other patient groups. [2]

In a research setting, needs assessment tools can also be used to develop targeted interventions and reliable outcome measures to assess the effectiveness of interventions. [2,4-6] Needs assessment tools can also be used to identify unmet health and healthcare needs of a population and determine what should be done, what can be done, and what is affordable. [12,13]

Evidence Summary

The needs assessment tools used in a palliative care setting include the:

These are not specific to older adults. The IPOS-Dem can be used for the regular assessment of aged care residents with dementia. The few needs assessment tools specific to the needs of older people are comprehensive geriatric assessments (CGAs) or specific to heart failure, chronic obstructive pulmonary disease (COPD) or carers of people with dementia. [2-11]

A comprehensive geriatric assessment (CGA) can be used to plan appropriate and coordinated care relevant to identified needs of older people who are frail or who have complex needs. [2,11] The five main domains assessed in a CGA are physical health, mental health, functional ability, social functioning and environmental context. [11] A CGA is commonly used to assist frail older people hospitalised with an acute illness [11] as this is where they are most likely to be assessed and where they will be at a critical phase in their care. [14] 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. [3]

The Needs Assessment for Progressive Disease-Heart Failure (NAT: PD-HF) (Figure 2, 3 and 4) assesses a range of needs for both heart failure (HF) patients and their carers. [2,9,10] It can be used in generalist as well as specialist palliative care settings. [10] Including the NAT: PD-HF in an annual heart failure review can facilitate the integration of palliative care for HF patients and improve overall quality of life at a more functional stage in the disease. [9] Combining the NAT: PD-HF and SPICT allows for a variety of triggers to flag the need for re-negotiating goals of care. [15] Other tools not specific to heart failure can be used in the care of people with chronic heart failure as they include indicators of

Several tools can be used to assess and address the needs of people living with chronic obstructive pulmonary disease (COPD). These include the Clinical COPD questionnaire (CCQ), the COPD Assessment Tool (CAT) and the Support Needs Approach for Patients (SNAP).

The IPOS-Dem is a tool used to assess how certain symptoms and problems have affected a resident with dementia over the previous week. [16] The tool assesses physical, functional, psychosocial, and practical aspects of the person’s life. Two questions consider the experience of the family. The Carers’ Needs Assessment for Dementia (CNA-D), Partnering for Better Health – Living with Chronic Illness: Dementia (PBH-LCI:D) and the Questionnaire consultation expectations (EAC) have been developed to assess the needs of carers of people living with dementia. [4-6] For more information visit the palliAGED Cognitive Impairment and Dementia evidence summary and the CareSearch Clinical Evidence topic Advanced Dementia.

Quality Statement

The quality of the included papers is acceptable to high quality.


Page updated 24 June 2022
 

  • References

  • About PubMed Search

  1. National Clinical Programme for Palliative Care. Palliative Care Needs Assessment Guidance. Ireland: National Clinical Programme for Palliative Care; 2014.
  2. Girgis A, Waller A. Palliative care needs assessment tools. In: Cherny N, Fallon M, Kaasa S, Portenoy RK, Currow DC, editors. Oxford Textbook of Palliative Medicine. 5th ed. Oxford, UK: Oxford University Press; 2015.
  3. 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.
  4. Kipfer S, Pihet S. Reliability, validity and relevance of needs assessment instruments for informal dementia caregivers: a psychometric systematic review. JBI Evid Synth. 2020 Apr;18(4):704-742. doi: 10.11124/JBISRIR-2017-003976.
  5. 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 Mar;32(3):274-287. doi: 10.1002/gps.4642. Epub 2016 Dec 16.
  6. Novais T, Dauphinot V, Krolak-Salmon P, Mouchoux C. How to explore the needs of informal caregivers of individuals with cognitive impairment in Alzheimer's disease or related diseases? A systematic review of quantitative and qualitative studies. BMC Geriatr. 2017 Apr 17;17(1):86. doi: 10.1186/s12877-017-0481-9.
  7. Gardener AC, Ewing G, Kuhn I, Farquhar M. Support needs of patients with COPD: a systematic literature search and narrative review. Int J Chron Obstruct Pulmon Dis. 2018 Mar 26;13:1021-1035. doi: 10.2147/COPD.S155622.
  8. Gardener AC, Ewing G, Mendonca S, Farquhar M. Support Needs Approach for Patients (SNAP) tool: a validation study. BMJ Open. 2019 Nov 19;9(11):e032028. doi: 10.1136/bmjopen-2019-032028.
  9. Crimmins RM, Elliott L, Absher DT. Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely Palliative Efforts for Heart Failure Patients in the Primary Care Setting. Am J Hosp Palliat Care. 2021 Jan;38(1):77-83. doi: 10.1177/1049909120920545. Epub 2020 Apr 22.
  10. Janssen DJA, Johnson MJ, Spruit MA. Palliative care needs assessment in chronic heart failure. Curr Opin Support Palliat Care. 2018 Mar;12(1):25-31. doi: 10.1097/SPC.0000000000000317.
  11. Parker SG, McCue P, Phelps K, McCleod A, Arora S, Nockels K, et al. What is Comprehensive Geriatric Assessment (CGA)? An umbrella review. Age Ageing. 2018 Jan 1;47(1):149-155. doi: 10.1093/ageing/afx166.
  12. Department of Health. PHN Program Needs Assessment Policy Guide 2021. Canberra: Australian Government Department of Health; 2021.
  13. McLeod H. The Need for Palliative Care in New Zealand: Technical Report (5.17MB pdf). Hanmer Springs, NZ: Ministry of Health; 2016 Jun.
  14. Stow D, Spiers G, Matthews FE, Hanratty B. What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis. Palliat Med. 2019 Apr;33(4):399-414. doi: 10.1177/0269216319828650. Epub 2019 Feb 18.
  15. Sobanski PZ, Alt-Epping B, Currow DC, Goodlin SJ, Grodzicki T, Hogg K, et al. Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement. Cardiovasc Res. 2020 Jan 1;116(1):12-27. doi: 10.1093/cvr/cvz200.
  16. Palliative care Outcome Scale (POS). Integrated POS (IPOS) for Dementia and Translations [Internet]. London: Cicely Saunders Institute; 2022. [cited 2022 May 16].

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]))