Holistic concerns – A patient perspective analysis of electronic Holistic Needs Assessments


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Rachel White1,Andrew Brittle1,Amanda Watson1,Riccardo Camon1
1Macmillan Cancer Support

Abstract

Background

People with cancer have a wide range of needs impacting all aspects of their lives. To help people with cancer live well, we need to be able to systematically identify and meet these needs. This can be done though an electronic Holistic Needs Assessment (eHNA). In 2015, almost 11,000 eHNA records were created in 59 hospital trusts across Great Britain. eHNAs are offered to people living with cancer at key points across the cancer pathway at times when the patient’s nurse judges it will be benefit.

Method

Data about concerns collected directly from patients through the eHNA is combined in more than 80% of cases with information on clinical factors inputted by their healthcare professional.  We analysed the database using descriptive statistics and principal component analysis.

Results

In 51% of care plans, there were no concerns expressed and in 12% only one was expressed. The most common concerns were ‘tired/exhausted or fatigued’ (12.8% of care plans), ‘worry, fear or anxiety’ (12.8%) and ‘pain’ (7.7%).

Fatigue, pain, worry, fear and anxiety are common concerns so they are often expressed together. We used principal component analysis to identify concerns that were more likely to occur together than expected from their overall frequency for example, ‘breathing difficulties‘, ‘getting around’ and ‘fatigue’.

Conclusion

Concerns are common and in 38% of care plans, people expressed more than one concern. This demonstrates the importance of support tailored to patients, as well as understanding more about the complexity of needs in the cancer population.

Currently there is very little systematic collection of data on patient concerns. So the eHNA dataset provides a unique resource for national and local service planners. As the number of eHNAs conducted grows, so too will the potential for this rich dataset as a real-world reflection of concerns expressed in a healthcare setting.