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) Date revised: October 2013 Approved by: Date of approval: 19 February 2014 Date issued: 24 April 2014 Lesley Barnett Lead Cancer Nurse Policy Approval and Compliance Group on behalf of Patient Safety Review Group Next review date: October 2016 Extended to March 2018 Target audience: Cancer and Palliative Care Practitioners Page 1 of 17
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 Date Issued Brief Summary of Changes Author Version 5 24 April 2014 Title change. Policy reviewed and reproduced using the new style format. Section on Roles and Responsibilities added. Lesley Barnett Version 4 June 2011 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 Version 3 October 2008 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 Version 2 March 2008 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 Page 2 of 17
Section Appendices Contents 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 Page No. Page 3 of 17
1. 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. Page 4 of 17
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 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. Page 5 of 17
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. Page 6 of 17
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. 5. 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 The use of HNA is monitored via annual patient surveys Who will carry out the Monitoring Cancer MDT and CNSs How often Annually How Reviewed/ Where Reported to 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 Training for new staff CNSs LCN As required 7. DEFINITIONS/ABBREVIATIONS CNS - Clinical Nurse Specialist HNA - Holistic Needs Assessment Page 7 of 17
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 Page 8 of 17
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 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 Page 9 of 17
Your initials:. Date completed:..././. COMMUNICATION AND INFORMATION ISSUES 1. Have you been able to talk to any of the following people about your condition? Yes 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 In the past month, have you been distressed or bothered by: Not at all Please circle one answer per line A little Quite a 2. Pain? 3. Loss of memory? 4. Headache? 5. Dry mouth? 6. Sore mouth? 7. Shortness of breath? 8. Cough? 9. Feeling sick (nausea)? 10. Being sick (vomiting)? Very much 11. Bowel problems (e.g. constipation, diarrhoea, incontinence)? 12. Bladder problems (urinary incontinence)? 13. Feeling weak? 14. Feeling tired? 15. Problems sleeping at night? 16. Feeling sleepy during the day? Page 10 of 17
PHYSICAL SYMPTOMS continued Not at all A little Quite a Very much 17. Loss of appetite? 18. Changes in your weight? 19. Problems with swallowing? 20. Being concerned about changes in your appearance? 21. Feeling restless and agitated? 22. Feeling that your symptoms are not controlled? PSYCHOLOGICAL ISSUES In the past month, have you been distressed or bothered by: Not at all Please circle one answer per line A little Quite a 23. Feeling anxious? 24. Feeling as if you are in a low mood? 25. Feeling confused? 26. Feeling as if you are unable to concentrate? 27. Feeling lonely? 28. Feeling that everything is an effort? 29. Feeling that life is not worth living? 30. Thoughts about ending it all? 31. The effect of your condition on your sexual life? Very much RELIGIOUS AND SPIRITUAL ISSUES In the past month, have you been distressed or bothered by: Please circle one answer per line Not at A little all Quite a 32. Worrying thoughts about death or dying? Very much 33. Religious or spiritual needs not being met? Page 11 of 17
INDEPENDENCE AND ACTIVITY Please circle one answer per line In the past month, have you been distressed or bothered by: Not at all A little Quite a Very much 34. Losing your independence? 35. Changes in your ability to carry out your usual daily activities such as washing, bathing or going to the toilet? 36. Changes in your ability to carry out your usual household tasks such as cooking for yourself or cleaning the house? 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 Quite a Very much 37. Feeling that people do not understand what you want? 38. Worrying about the effect that your illness is having on your family or other people? 39. Lack of support from your family or other people? 40. Needing more help than your family or other people could give? TREATMENT ISSUES Please circle one answer per line In the past month, have you been distressed or bothered by: Not at all A little Quite a Very much 41. Side effects from your treatment? 42. Worrying about long term effects of your treatment? Page 12 of 17
PERSONAL ISSUES 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? Yes No 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 Page 13 of 17
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 Page 14 of 17
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 Page 15 of 17
APPENDIX 2 DISTRESS THERMOMETER Page 16 of 17
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