Holistic Needs Assessment Rhetoric or Reality?

Transcription

1 Holistic Needs Assessment Rhetoric or Reality? Natalie Doyle Nurse Consultant Living With & Beyond Cancer 1

2 2 What is Holistic Needs Assessment (HNA)? a holistic health and social care assessment undertaken in order to identify supportive and palliative care needs of an individual and to trigger any specialist assessment that may be required. NCAT 2007

3 3 What should be included in an assessment? Background information and assessment preferences Physical needs Social and occupational needs Psychological well-being Spiritual needs NCAT 2007

4 4 Holistic Needs Assessment The process of assessment should be one of partnership between patient and professional. Self-assessment is a useful way to identify issues of particular concern to the patient, for subsequent discussion with the assessor. Assessment should take no more than 30 minutes on average. NCAT 2007

5 5 Key points of assessment Around the time of diagnosis Commencement of treatment Completion of the primary treatment plan The point of recognition of incurability The beginning of end of life The point at which dying is diagnosed At any other time that the patient may request At any other time that a professional carer may judge necessary Each new episode of disease recurrence NCAT 2007

6 6 Local ICS Metrics Around the time of diagnosis Completion of the primary treatment plan NCAT 2007

7 7 The Tools There is no proforma or tool designed for the holistic assessment of supportive and palliative care needs for adults with cancer. Existing published tools assess either a more limited range of cancer-related needs or assess in depth a specific area of need. Healthcare teams may wish to utilise one or more existing tools as part of a holistic assessment; however, in all cases it must be ensured that the assessment covers the full range of needs listed in this guidance. (NCAT 2007)

8 8 The Tools The guidance is for the assessment of patients needs and has not been designed to assess the needs of carers. However, it is recognised that carers needs might be identified during the course of the patient assessment, and this may raise a need for further assessment and action. NCAT 2007

9 9 Concerns Thermometer

10 10 Concerns Thermometer Care Plan

11 11 Why are we doing this? 30% of people reported 5 unmet needs a year after diagnosis Armes et al 2010

12 12 Assessment the old fashioned way How do you know what someone is thinking or is concerned about? Do you second guess based on experience? Do you always get it right? Would you know if you were wrong? Are you surprised when you are wrong? What happens then?

13 13 Impasse Health care professionals are generally poor at detecting distress Oncologists leave it to the patient to raise concerns Patients rarely raise physical, psychological or spiritual concerns Brennan et al 2011

14 14 Locus of Control Rotter 1966

15 15 Teachable Moment Opportunities exist to promote lifestyle changes that may improve the length and quality of life. Demark-Wahnefried et al, 2005

16 16 A substantial number of reports suggest that cancer survivors spontaneously adopt lifestyle changes in hopes of achieving improved health Riding the Crest of the Teachable Moment: Promoting Long-Term Health After the Diagnosis of Cancer (2005)Demark-Wahnefried W, Aziz N.M., Rowland J.H., and Pinto B.M. Journal of Clinical Oncology 23 (24)

17 17 Although a substantial proportion of cancer survivors spontaneously initiate positive behavioural changes, many do not. Males and those who are less educated, over the age of 65, or who live in urban areas are less likely to either undertake healthful changes in behaviour or maintain them. Riding the Crest of the Teachable Moment: Promoting Long-Term Health After the Diagnosis of Cancer (2005)Demark-Wahnefried W, Aziz N.M., Rowland J.H., and Pinto B.M. Journal of Clinical Oncology 23 (24)

18 18 The Professionals Spirit is willing but the flesh is weak Time is the enemy What happens when there isn t anything you can do? If it isn t documented it didn t happen

19 19 Practical Issues Time Skills IT Working across organisations Availability of specialist services Local variations Documentation

20 20 Addressing the Issues Cancer education Service evaluation Motivational interviewing/solution focused care Skills workshops Thinking outside of the box Collaborative working Developing a case of need for services Commissioning

21 21 My Story Service Evaluation Integrated Cancer System

22 22 As with many things It ain t what you do it s the way that you do it and that s what gets results.

23 23 Contact Natalie Doyle Nurse Consultant, Living With & Beyond Cancer NHSFT Fulham Road London SW3 6JJ Tel ext 1791