Download Holistic Needs Assessment (HNA) for Adult Cancer Patients

PAT/T 28
v.5
Please Note: This policy is currently under review and is still fit for purpose.
Holistic Needs Assessment (HNA)
for Adult Cancer Patients
Guidelines
Handbook to accompany these guidelines is available from the Lead
Cancer Nurse in hard copy or electronically
This procedural document supersedes: PAT/T 28 v.4 – Guidelines for Holistic Needs
Assessment for Adult Cancer Patients using SPARC (Sheffield Profile for Assessment
and Referral to Care)
Did you print this document yourself?
The Trust discourages the retention of hard copies of policies and can only guarantee
that the policy on the Trust website is the most up-to-date version. If, for
exceptional reasons, you need to print a policy off, it is only valid for 24 hours.
Author/reviewer: (this
version)
Lesley Barnett – Lead Cancer Nurse
Date revised:
October 2013
Approved by:
Policy Approval and Compliance Group on behalf of
Patient Safety Review Group
Date of approval:
19 February 2014
Date issued:
24 April 2014
Next review date:
October 2016 – Extended to November 2017
Target audience:
Cancer and Palliative Care Practitioners
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Amendment Form
Please record brief details of the changes made alongside the next version number.
If the procedural document has been reviewed without change, this information will
still need to be recorded although the version number will remain the same.
Version
Version 5
Date Issued
24 April
2014
Brief Summary of Changes

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Version 4
June 2011




Version 3
October
2008


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Version 2
March 2008

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Author
Title change.
Policy reviewed and reproduced using the
new style format.
Section on Roles and Responsibilities
added.
Lesley Barnett
Page 1 Handbook to accompany this policy is
available from LCN Lesley Barnett in hard
copy and electronically
Contents page numbers updated
Item 2.2 added
Appendix B added
Lesley Barnett
New policy for Holistic needs assessment completely re-written, please read in full
New Holistic needs assessment tool -SPARC
available from Supplies. WPR number from
Lead Cancer Nurse
New handbook - available shortly in hard
copy from LCN Lesley Barnett and on the
hospital intra-net.
Lesley Barnett
Added a contents page
Item 4.1 - first bullet point - changed to…
‘Approximately 4 - 6 weeks post diagnosis
according to each MDT’s operational
policy.’
Item 4.2 - first bullet point - changed to…
‘re-assessed within 4 weeks after
commencement of supportive
intervention.’
Removed item 6
Gill Horne
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Contents
Page
No.
Section
1
Introduction
4
2
Purpose
4
3
Duties and Responsibilities
5
4
Procedure
5
5
Training/Support
7
6
Monitoring Compliance with the Procedural Document
7
7
Definitions
7
8
Equality Impact Assessment
8
9
Associated Trust Procedural Documents
8
Appendix 1
SPARC Tool
9
Appendix 2
Distress Thermometer
16
Appendices
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1.
v.5
INTRODUCTION
We know that the incidence of cancer is increasing and, because we are getting
better at treating it, the prevalence is increasing even faster. In simple terms this
means that year on year more people are living with a diagnosis of cancer. This is the
reality behind the ‘survivorship’ agenda contained within the Cancer Reform
Strategy. At the heart of the survivorship agenda (now being taken forward by the
National Cancer Survivorship Initiative - NCSI) is the fact that patients will have their
own set of needs as a result of their cancer diagnosis and unless we understand what
these needs are and make plans as to how they can be supported we will be allowing
significant levels of Morbidity to persist and possibly become chronic problems.
In addition to the survivorship agenda are the recommendations contained within
the Improving Outcomes Guidance (IOG) for supportive and palliative care. The IOG
talks about the importance of needs assessment at numerous points in relation to
psychological, rehabilitation, spiritual and information needs. Fundamental to the
IOG is the concept of Holistic Needs Assessment that seeks to identify all the needs
of the patient as the first step to meeting those needs.
Lastly, the area of information remains high on the agenda. We now have lots of
information we can give to our patients but have failed to make significant
improvements in how that information is delivered. For this reason the ‘information
prescription’ concept has come to the fore and promotes the timely and
personalised giving of information.
This policy is intended to inform the practice of clinical nurse specialists, consultants,
oncologists and Allied health professionals working in cancer and palliative care.
Handbook to accompany these guidelines is available from the Lead Cancer Nurse in
hard copy or electronically.
2.
PURPOSE
Holistic Needs Assessment (HNA)
The Network Supportive and Palliative Care Group (NSPCG) have developed a model
of assessment based on a patient completed questionnaire which acts as a
‘springboard’ to a conversational style of assessment. The Sheffield Profile for
Assessment and Referral to Care (SPARC) questionnaire, see Appendix 1, covers a
variety of physical, psychological, social, spiritual and information needs. A
healthcare professional uses the questionnaire to help inform a discussion with the
patient about their concerns and then formulates an action plan which may involve
signposting, referral or dealing with an issue directly where appropriate. It is
anticipated that the HNA will be carried out at key points on the cancer journey and
this may vary between cancer sites.
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The Network Supportive and Palliative Care Group (NSPCG) have agreed that the
Distress Thermometer, see Appendix 2, can be used as an alternative to SPARC
where clinically indicated.
3.
DUTIES AND RESPONSIBILITIES
Network Supportive and Palliative Care Group
The Network group is responsible for the strategic direction of HNA process ensuring
equity across the localities. This is monitored through National Cancer Peer Review.
Cancer Management Team
Cancer Management team are responsible for ensuring cancer services are high
quality, safe and cost effective. Also ensuring cancer services are using evidence
based research and practice, this includes HNA.
Lead Cancer Nurse
The Lead Cancer nurse is responsible for the implementation of the policy and its
review.
The Lead Cancer nurse is responsible for monitoring use of HNA through National
Cancer Peer Review, Cancer Outcomes Services Dataset and Patient Experience
surveys.
Clinical Nurse Specialist
All CNSs are responsible for implementation of HNA in practice.
All cancer patients should be offered a HNA at key points in their pathway and the
CNSs are responsible for ensuring this occurs.
4.
PROCEDURE
4.1
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Timing of routine screening – use of questionnaire - see handbook
First screening is advised to be offered to patients post diagnosis according to
each MDT’s operational policy.
Second routine screening to be offered post completion of cancer treatment/
surgery.
Unless a patients condition changes or in the clinician’s clinical judgement,
the need for continued routine screening is not suggested. However :
Subsequent routine screening to be offered under the following
circumstances:
o Post diagnosis of recurrent or advanced disease at the stage when a
patient is informed there is no further active treatment planned.
o The patient requests re assessment
4.2. Administering SPARC – see handbook
4.2.1 If the tool is not being used within a home setting then privacy should
be obtained in the clinic/ward through use of a quiet room.
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All patients should be invited to complete SPARC, (to help assess how
they feel). However they have the right to refuse to be screened.
Patients with special needs (for e.g. visually impaired, illiterate, fatigued)
should be offered support to complete SPARC.
It may not be appropriate to use this tool with patients in the last
days/weeks of life, highly distressed or acutely fatigued. Professionals
should use their professional judgement on its appropriateness for each
individual patient.
Patients who read in a different language to English should be offered the
tool in the appropriate translation.
The key worker will be the health professional responsible to administer
the tool or will delegate responsibility to an appropriately trained person.
Scores of SPARC should be checked by the health professional responsible
for administering the tool and medium to high scores require discussing
with patients through a listening interview as soon as possible (with
patients’ consent the relatives may be included in the listening interview).
It is recommended where possible, that the same health professional
administers SPARC on re-screening to provide continuity of care.
4.3. Interventions
4.3.1 Interpretation of Scores –see handbook
 A score of 0 suggests there is no concern in this area

A score of 1 should probably not be given high priority especially if there are
a lot of other higher scores. However, if it is one of the higher scores it may
be appropriate to explore the concern. It may also be appropriate to explore
scores of 1 if they have been present on previous assessments.

A score of 2 or 3 should be explored in more detail. This can be difficult if
there are a lot of 2’s and 3’s. In this situation you may want to explore the
patient’s greatest concerns first and arrange to see them again to continue
on the assessment or it may be possible to group some concerns together
and offer appropriate support based on a less detailed assessment. There is
no right answer but remember that the aim is to assess in enough detail to be
able to offer the right support, signposting and referral.
An appropriate response to a completed SPARC questionnaire will take into
account the individual scores, the patients own prioritisation, the chronicity
of any concerns and the overall context (but not the overall score).
Outcomes from the screening should be discussed with the patient.
4.4. Recording of SPARC
4.4.1 The date of screening and score should be recorded in the patient’s
medical notes and the date of the next routine or reassessment
screening date also requires recording.
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A pre-printed sticker should be inserted into the medical notes and filled
in appropriately with details of:
o date of screening,
o scores (if screened),
o date of next screening
o which service (if necessary) the patient is referred to.
o The completed SPARC form should be filed in the patients case
notes in the CNS documentation section
o The patient should be offered a copy of the completed SPARC
form
o The SPARC form or a summary should be communicated to the
patients GP and any other relevant health care professionals
involved in that patients care.
It is the key workers’ responsibility to ensure that the next screening date
is communicated to the patient’s health care team as appropriate (this
will normally be the patient’s GP).
If the patient is not assessed or declines use of SPARC screening tool
please record in the patients case notes.
TRAINING/ SUPPORT
Training available from CNSs or Lead Cancer Nurse for new staff as required.
6.
MONITORING COMPLIANCE WITH THE PROCEDURAL
DOCUMENT
What is being Monitored
Who will carry out
the Monitoring
The use of HNA is
monitored via annual
patient surveys
Cancer MDT and
CNSs
Annually
Cancer Management
Team
Peer review
The use of HNA is
monitored at the
quarterly CNS
meetings with the
Lead Cancer Nurse
Lead Cancer
Nurse
Quarterly
Lead Cancer Nurse
CNSs
LCN
As required
Training for new staff
7.
How often
DEFINITIONS/ABBREVIATIONS
CNS - Clinical Nurse Specialist
HNA - Holistic Needs Assessment
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How Reviewed/
Where Reported to
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v.5
IOG - Improving Outcomes Guidance
MDT - Multi-Disciplinary Team
NCSI - National Cancer Survivorship Initiative
NSPCG - Network Supportive and Palliative Care Group
SPARC - Sheffield Profile and Assessment for Referral for Care
8.
EQUALITY IMPACT ASSESSMENT
An Equality Impact Assessment (EIA) has been conducted on this procedural
document in line with the principles of the Equality Analysis Policy (CORP/EMP 27)
and the Fair Treatment For All Policy (CORP/EMP 4).
The purpose of the EIA is to minimise and if possible remove any disproportionate
impact on employees on the grounds of race, sex, disability, age, sexual orientation
or religious belief. No detriment was identified.
A copy of the EIA is available on request from the HR Department.
9.
ASSOCIATED TRUST PROCEDURAL DOCUMENTS
Mental Capacity Act 2005 Policy and Procedure - PAT/PA 19
Privacy and Dignity Policy - PAT/PA 28
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APPENDIX 1
Holistic Needs assessment tool - For information only
Please do not print but order copies from Supplies.
Place your unit’s logo and title here
Sheffield Profile for Assessment
and Referral to Care (SPARC)
We would like to know a bit more about
you and your concerns.
Please fill in this questionnaire (with help from a
relative or carer if needed) and return it to one of our
team.
There are no “right” or “wrong” answers.
If you are unsure of a question, please leave it blank.
THANK YOU
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PAT/T 28
Your initials:……………….
Date completed:....../……./…….
COMMUNICATION AND INFORMATION ISSUES
1. Have you been able to talk to any of the following people about
Yes
your condition?
v.5
No
a. Your doctor
b. Community nurse
c. Hospital nurse
d. Religious advisor
e. Social worker
f. Family
g. Other people (please state):
PHYSICAL SYMPTOMS
Please circle one answer per line
In the past month, have you been distressed or
bothered by:
Not at
all
A little
bit
Quite a
bit
Very
much
2.
Pain?
0
1
2
3
3.
Loss of memory?
0
1
2
3
4.
Headache?
0
1
2
3
5.
Dry mouth?
0
1
2
3
6.
Sore mouth?
0
1
2
3
7.
Shortness of breath?
0
1
2
3
8.
Cough?
0
1
2
3
9.
Feeling sick (nausea)?
0
1
2
3
10.
Being sick (vomiting)?
0
1
2
3
11.
Bowel problems (e.g. constipation, diarrhoea,
incontinence)?
0
1
2
3
12.
Bladder problems (urinary incontinence)?
0
1
2
3
13.
Feeling weak?
0
1
2
3
14.
Feeling tired?
0
1
2
3
15.
Problems sleeping at night?
0
1
2
3
16.
Feeling sleepy during the day?
0
1
2
3
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Not at
all
PHYSICAL SYMPTOMS continued
A little
bit
Quite a
bit
v.5
Very
much
17.
Loss of appetite?
0
1
2
3
18.
Changes in your weight?
0
1
2
3
19.
Problems with swallowing?
0
1
2
3
20.
Being concerned about changes in your
appearance?
0
1
2
3
21.
Feeling restless and agitated?
0
1
2
3
22.
Feeling that your symptoms are not controlled?
0
1
2
3
PSYCHOLOGICAL ISSUES
In the past month, have you been distressed or
bothered by:
Please circle one answer per line
Not at
all
A little
bit
Quite a
bit
Very
much
23.
Feeling anxious?
0
1
2
3
24.
Feeling as if you are in a low mood?
0
1
2
3
25.
Feeling confused?
0
1
2
3
26.
Feeling as if you are unable to concentrate?
0
1
2
3
27.
Feeling lonely?
0
1
2
3
28.
Feeling that everything is an effort?
0
1
2
3
29.
Feeling that life is not worth living?
0
1
2
3
30.
Thoughts about ending it all?
0
1
2
3
31.
The effect of your condition on your sexual life?
0
1
2
3
RELIGIOUS AND SPIRITUAL ISSUES
In the past month, have you been distressed or
bothered by:
Please circle one answer per line
Not at
all
A little
bit
Quite a
bit
Very
much
32.
Worrying thoughts about death or dying?
0
1
2
3
33.
Religious or spiritual needs not being met?
0
1
2
3
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INDEPENDENCE AND ACTIVITY
v.5
Please circle one answer per line
In the past month, have you been distressed or
bothered by:
Not at
all
A little
bit
Quite a
bit
Very
much
34.
Losing your independence?
0
1
2
3
35.
Changes in your ability to carry out your usual
daily activities such as washing, bathing or
going to the toilet?
0
1
2
3
36.
Changes in your ability to carry out your usual
household tasks such as cooking for yourself or
cleaning the house?
0
1
2
3
FAMILY AND SOCIAL ISSUES
Please circle one answer per line
In the past month, have you been distressed or
bothered by:
Not at
all
A little
bit
Quite a
bit
Very
much
37.
Feeling that people do not understand what
you want?
0
1
2
3
38.
Worrying about the effect that your illness is
having on your family or other people?
0
1
2
3
39.
Lack of support from your family or other
people?
0
1
2
3
40.
Needing more help than your family or other
people could give?
0
1
2
3
TREATMENT ISSUES
Please circle one answer per line
In the past month, have you been distressed or
bothered by:
Not at
all
A little
bit
Quite a
bit
Very
much
41.
Side effects from your treatment?
0
1
2
3
42.
Worrying about long term effects of your
treatment?
0
1
2
3
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PERSONAL ISSUES
Yes
43.
Do you need any help with your personal affairs?
44.
Would you like to talk to another professional about your
condition or treatment?
4
45.
Would you like any more information about the following?
a. Your condition
b. Your care
c. Your treatment
d. Other types of support
e. Financial issues
f. Other (please state):
Are there any other concerns that you would like us to know about?
Carry on over the page if needed
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No
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You can use this section to jot down any questions that you want to ask your doctors or
other caring professionals
Question 1
Question 2
Question 3
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Finally please circle a number (0-10) that best describes how much distress in general you
have been experiencing over the past week (including today)
10
Maximum Distress
9
8
7
6
5
4
3
2
1
0
No Distress
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PAT/T
APPENDIX 2
DISTRESS THERMOMETER
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