Operationalising needs-based assessment
1Flinders University, Adelaide, Australia
Needs-based care is crucial to ensuring that the people who have the most complex needs are identified early and systematically in order to ensure that as much is done as possible to address their needs. This is crucial in a complex health system where demands will always outstrip supply, and where those demands may not reflect the genuine underlying need of every person making them.
A systematic approach is required. The assessment is the responsibly of every health professional. This lies with primary care, tertiary services and in every health setting.
There are a number of tools that are available for such processes. The principles of such tools include the needs for them to be brief, easily learned, excellent inter-rater reliability and significant face validity.
These tools, in order to address the complexities of people with advancing cancers, requires a patient aspect dealing with all of the domains of personhood (physical, social, sexual, existential, emotional, financial), the well-being of caregivers as well as their willingness to provide that care and any professional issues that may also impinge on the ability to provide care.
Importantly, available data to date suggests that such tools do not make clinical consultations longer (and may actually shorten them) while at the same time improving patient satisfaction because the consultation has better met with his/her needs.
Ultimately, at a systems level, systematic approaches need to identify the changing and evolving needs of patients and their caregivers over the course of advancing cancer.