1. Holistic Needs Assessment: an acute hospital’s story….
Nicky Laking, Nurse Consultant & Lead Cancer Nurse
Dr Clare Davies, Consultant Clinical Psychologist

2. Background Cancer Action Team 2007:
‘All NHS patients with a diagnosis of cancer and/or receiving care in any setting should be offered this assessment.’
North East Cancer Network – Holistic Assessment
Developed with permission from Northern Comprehensive Cancer Network, USA.

3. Methodology
Working group to explore delivery and effectiveness of the Holistic Needs Assessment (HNA).
Minimal modification to HNA.
Identification of training needs.
Establishment of the ability to audit
Formation of a pilot group

4. Score: __________________
This screening tool is aimed to encourage professionals and patients to explore current problems and issues that may be affecting patients’ physical, psychological, social and spiritual well-being.
The outcome (including patient score) of this assessment is to be documented in the patients ongoing record with an agreed plan of care and referral on for symptom control, rehabilitation, social, spiritual or psychological care where necessary.
My appearance / Body image
Skin Dry / Itchy / wound healing
Swollen (limbs/abdomen)
Weight Changes – loss or gain
Sexual Problems
Hair Loss
Other
Reduced Independence
Bathing / Dressing
Getting Around
Toileting Difficulties
Constipation
Diarrhoea
Stoma
Changes in passing urine
Physical Symptoms
Difficulties in Communicating
Breathing
Pain
Temperature
Change in sensation: hands/feet
Seizures
Eating Difficulties
Indigestion
Sores /painful mouth
Nausea/vomiting
Taste changes
Swallowing difficulties
Change in appetite
Food preparation
Any other factors
Social Concerns
Coping with dependents
Work/School
Hobbies/Leisure activities
Housing
Finances
Travel
Carer
Relationships
Emotional Wellbeing
 Sadness
Fears
Worries / Anxieties
Anger
Alcohol/smoking/other drugs
Unable to express feelings
Feeling isolated
Loss of dignity
Forgetful/confused
Stress
Loss of control
Spiritual / Religious Concerns
Questioning values and beliefs
Sense of meaning
Issues relating to dying and death
Rest / Activity
Sleep
Fatigue
Tiredness
Alteration in sleep pattern
Identify the number (1-10) that best describes how much distress has been experienced over recent weeks, if ‘0’ is no distress and ‘10’ is high levels of distress or anxiety.
Score: __________________

5. 2 3 1 4  Finances Sadness  Stoma  Sleep  Change in appetite
This screening tool is aimed to encourage professionals and patients to explore current problems and issues that may be affecting patients’ physical, psychological, social and spiritual well-being.
The outcome (including patient score) of this assessment is to be documented in the patients ongoing record with an agreed plan of care and referral on for symptom control, rehabilitation, social, spiritual or psychological care where necessary.
My appearance / Body image
Skin Dry / Itchy / wound healing
Swollen (limbs/abdomen)
Weight Changes – loss or gain
Sexual Problems
Hair Loss
Other
Reduced Independence
Bathing / Dressing
Getting Around
Toileting Difficulties
Constipation
Diarrhoea
 Stoma
Changes in passing urine
Physical Symptoms
Difficulties in Communicating
Breathing
Pain
Temperature
Change in sensation: hands/feet
Seizures
Eating Difficulties
Indigestion
Sores /painful mouth
Nausea/vomiting
Taste changes
Swallowing difficulties
 Change in appetite
Food preparation
Any other factors
Social Concerns
Coping with dependents
Work/School
Hobbies/Leisure activities
Housing
 Finances
Travel
Carer
Relationships
Emotional Wellbeing
Sadness
Fears
Worries / Anxieties
Anger
Alcohol/smoking/other drugs
Unable to express feelings
Feeling isolated
Loss of dignity
Forgetful/confused
Stress
Loss of control
Spiritual / Religious Concerns
Questioning values and beliefs
Sense of meaning
Issues relating to dying and death
Rest / Activity
 Sleep
Fatigue
Tiredness
Alteration in sleep pattern 2 3 1
Identify the number (1-10) that best describes how much distress has been experienced over recent weeks, if ‘0’ is no distress and ‘10’ is high levels of distress or anxiety.
Score: ______7___________ 4

6. NECN HOLISTIC ASSESSMENT OF CONCERNS
Developed with kind permission of the Northern Comprehensive Cancer Network (2005) from the Distress Thermometer Group
NECN HOLISTIC ASSESSMENT OF CONCERNS
Patient Details
Today’s date:
Previous assessment date:
Staff member to print and sign name:
Assessment number:
Comment
Diagnosis
Location
Duration of interview (in minutes):
Copy given to patient Yes  No 
Highest Ranked Concerns
Rating
0-10
Description and history of concern
Plan of action 1 2 3 4

7. Pilot Group 5 site cancer specialist teams (11 specialist nurses)
10 assessments per tumour group
SPCT, Urology, UGI, Breast, Haematology (All on JCUH site)
3 month pilot, or 10 assessments completed
Training session.

8. Training 3 hour session – Nicky and Clare
Presentation: Background to Holistic Assessment, What do we mean by distress?, What deters patients from expressing concern, exploratory / open-ended questions *, Therapeutic Conversation.
Role-play: modelling use of administering HNA.
Introduction, Eliciting information, action points.
Group practice: scenarios, specific cases.
Documentation and Quick Guide.
* Those staff that have not undertaken adavanced comms

9. Training
Information Folder: “The assessor should have access to up to date information about local service providers, referral criteria and support services”. (Cancer Action Team)
Macmillan Information Centre – updating information.

10. Pilot Group Results
9 out of 11 individual questionnaires were returned (89%)
4 of the 5 specialist services (80%)
Years spent as a specialist nurse ranged from 1 to 15 years ( mean average 7 years).

14. Improved Communication / focused time
Patient feedback
Improved Communication / focused time
“Having someone to talk too”
“I felt someone cared”
“Spending time with clinical nurse specialist herself was really beneficial for me”
“The time felt focused on me”
“The opportunity was never there before to actually ask questions without a rush

15. Chance to discuss issues that would not normally come up in conversation
To be asked about sexual and financial problems was a chance for me to think about these things – I hadn’t really”
“I found it helpful to talk about when I could resume a sex life”
“I didn’t think I could offload about all my problems in clinic – I was asked bout things I was worrying about but usually I am just in and out of clinic”

16. Conclusion Time Not all patients appropriate Environment
Patients verbalised a positive process
Peer review measure
Community environment a positive experience for both patient and staff

17. Challenges Engagement of staff Developing the therapeutic conversation
Ensuring transfer of information to others
Recording the use of HNA

18. Positive experiences Engagement of staff
Involvement of Macmillan Information Centre
Development of the information folder
HNA training sessions
Feedback from patients

19. Recommendations and Outcomes
Full role out of HNA across all tumour sites
March 2012
6 month evaluation of the tool
June 2012
3 month audit of its use
July 2012
Full compliance with the peer review measure
May 2012
6 month review – opportunity to feedback in a larger group, discuss supervision needs

20. Who did we train? Nurse Consultants Clinical Sisters Specialist Nurses
Therapy Radiographers
Ward & Clinic Staff
90% staff undertaken Advanced Comms, Some Level 2 Psychology trained, All band 6 or above
Plan to train key AHPs?

21. Raising Awareness Clinicians – oncology/ haematology meetings
MDT meetings
Ultimately benefit patient care

22. Acknowledgments
Dr James Brennan, Consultant Clinical Psychologist. Bristol Haematology & Oncology Centre. University Hospitals Bristol NHS Foundation Trust.
Specialist Nurses for embracing the tool
Macmillan Information Centre
Andrea Harris Macmillan Specialist Nurse – SPCT