The holistic needs assessment in cancer care: identifying barriers and facilitators in the UK and Canada

Abstract

Background: Personalised information and support can be provided to cancer survivors using a structured approach. Assessment tools such as the Holistic Needs Assessment (HNA) in the UK and the Comprehensive Problem and Symptom Screening (COMPASS) in Canada have been recommended for use in practice. However, completion of the HNA/COMPASS is not widely embedded into practice and Clinical Nurse Specialists (CNSs) express concern about their ability to respond to issues raised by patients.

Aims: To investigate CNS's views on HNAs/COMPASS and identify barriers and facilitators to implementation.

Methods: This international on‐line survey using a snowball technique recruited CNSs across the UK and one Canadian province (Manitoba) in 2017.

Results: A total of 306 CNSs in the UK and 162 in Canada completed the on‐line survey. In the UK, HNAs were completed primarily prior to and immediately after treatment. In Canada, COMPASS was usually completed at every appointment. Participants expressed concerns that HNAs/COMPASS were becoming “tick‐box exercises” which did not meet patients' needs. Barriers to completion were time, staff shortages, lack of confidence, privacy and signposting of resources. Facilitators were privacy for confidential discussions, training, confidence in knowledge and skills, and signposting of resources.

Conclusions: That so many busy CNSs completed this survey demonstrates the importance they attach to HNAs and COMPASS. The challenges faced with implementing these assessments into everyday practice require training, time, support services and an appropriate environment. It is vital that the HNA and COMPASS are conducted at optimum times for patients to make the best use of time and resources.