Use of the Needs Assessment Tool: Progressive Disease –Cancer: identification of and planned actions for cancer patients in primary care

Problem

People with cancer, and their relatives, may experience unmet needs especially those with progressive disease. General Practitioners (GPs) are well-placed to provide palliative care but may have varying interests, skills and confidence in this field. Systematic assessment increases the number of patient concerns identified, including those that the patient may not perceive to be legitimate to raise.The Needs Assessment Tool:Progressive Disease-Cancer (NAT:PD-C) is a clinician-rated tool for daily practice assessing three dimensions: patient’s well-being; ability for the caregiver/family to care; caregiver’s well-being. It is currently being validated for use in primary care with cancer patients.Aim: To explore the i) concerns identified by GPs using the NAT:PD-C; ii) actions recommended by the GPs to address the concerns; iii) influence of clinician experience on identification and actions.

Approach

Exploratory secondary analysis of data collected for a psychometric validation study. Participants were 48 GPs: 24 with >10 years experience. Each completed a NAT:PD-C tool either in a patient consultation, or following observation of video-recorded consultation, with a cancer patient. Face-to-face and video consultations were not distinguished in this analysis. Levels and numbers of concern (levels: none, some/potential, significant: numbers; maximum 13 concerns per NAT:PD-C) and actions planned (managed directly, managed within the primary care team, referral required) were noted. Patients were receiving usual care from their GPs.

Findings

262/624 (42%) of all possible concerns (13x48) were diverse; identified across all three dimensions. The most frequent concerns (some or significant) related to patient’s physical symptoms (41/48; 85%), followed by problems with daily living activities (39/48; 81%), and family/caregiver distress about physical symptoms (29/48; 60.4%). The least identified concerns regarded carer/family distress about financial/legal matters (5/48; 10%). Actions were as follows: 102/262 (39%) concerns identified managed directly by the GP, 43/262 (16%) within the primary care team, 34/262 (13%) referred to a range of other services (e.g. specialist palliative care, oncology, podiatry). The GP’s level of experience did not appear to influence numbers of concerns identified or planned action.

Consequences

Physical symptoms were the most commonly identified, but concerns were numerous and wide-ranging illustrating the variety of skills required to care for these patients. Most concerns were managed directly by the GP irrespective of experience. All patients were receiving usual care and therefore new/previously recognised concerns cannot be distinguished using this method. However, we assume that at least the new referrals were newly identified concerns now apparent through the systematic approach of the NAT:PD-C. The NAT:PD-C appears to be useful in bringing a consistent approach to an inherently inconsistent assessment.