Aims: This study examined 1) approaches used by health professionals to administer an unmet needs assessment tool in the consultation setting, 2) potential of this tool to facilitate discussion of psychosocial issues, and 3) whether use of the tool by clinicians alters the length of consultations with patients with advanced cancer.
Methods: Anaudiotaping sub-study was undertaken as part of an interrupted time series study of the impact of systematic utilisation of the Palliative Care Needs Assessment Tool (PC-NAT) on the health outcomes and service utilisation of individuals with advanced cancer and their caregivers. The main trial included 219 outpatients across four hospitals in NSW who were diagnosed with advanced cancer and aged 18 years or older. Of 45 patients at one site who were asked for consent to audio-tape their consultations, 20 agreed (oncologist also agreed). Audio-recording were transcribed and thematic analysis was undertaken; and the mean length of consultations in minutes was determined.
Results: Despite an academic detailing approach to introduce the PC-NAT to clinicians, it was not implemented as anticipated, with minimal integration of the tool into the consultation and little explanation of its function given by oncologists. The use of the tool did not increase discussion of psychosocial issues; the majority of consultation time pertained to medical issues. Coding of consultation content revealed comparable empathy levels across medical and psychosocial concerns. However, codes which reflected “dismissing” or “denying” the concern were more frequently recorded for psychosocial concerns compared to medical concerns. The PC-NAT did not significantly lengthen consultations in which it was used.
Conclusions: People with advanced cancer report high unmet psychosocial needs. Staff training to enhance understanding and timely assessment and response to unmet needs as part of routine care is warranted to facilitate use of a needs assessment tool and discussion of psychosocial issues.
Funding: Project - Australian Government Department of Health & Ageing; Professor Girgis - a Cancer Institute NSW grant