Preconditions of ‘meaningful’ Holistic Needs Assessment: The basis for impact


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Lydia Briggs, Jessica Corner, Christopher Bailey, Joanne Cooper, Holly Blak

Abstract

Background

Globally, the number of people living with or beyond a breast cancer diagnosis is rapidly increasing. A breast cancer diagnosis has physical, psychological and social impacts for the individuals concerned. The concepts of ‘Personalised Care’ (formerly the ‘Recovery Package’) were introduced in the UK as part of a national agenda to target these issues, of which ‘Holistic needs assessment’ (HNA) is a core element. Few studies explore experiences of HNA from the perspective of either healthcare professionals or those who are diagnosed, but there is some indication that the contribution of the (e)HNA to addressing the concerns arising from breast cancer diagnosis is complex, and often minimal.  

Method

The study adopted a multiple case-study approach, incorporating two Acute NHS Trusts and four hospital sites. A total of 24 women with breast cancer, and 24 staff were recruited. Data collection involved face-to-face and telephone interviews, observations and document analysis (Care Plans) presenting a case around the HNA at each site. A Framework Analysis approach was adopted to identify key categories and linkages between the data. 

Results

Findings highlighted complex variables which influenced the contribution of HNA to individuals with cancer. For example format (such as timing and location) and factors which influenced openness, honesty and how an assessment was approached, many of which were due to individual preferences or experiences. The above categories also existed for staff, alongside organisational factors such as accountability, confidence and resistance.

Conclusion

The ‘concept’ of what the assessment aimed to achieve was meaningful to women, as was the tangible support provided by the Care Plan. However, challenges and room for improvement were noted by both staff and women in HNA delivery and implementation processes. A series of recommendations for practice have been made to support increasingly personalised and successful delivery of HNA in the future.

Impact statement

This study has generated a series of practice recommendations to maximise the value of HNA for individuals with cancer, which incorporate the challenges and considerations of both individuals with cancer and staff.