Routine assessment of unmet needs in individuals with advanced cancer and their caregivers: A qualitative study of the palliative care needs assessment tool (PC-NAT)

Purpose: To examine (1) approaches used by oncologists to administer the palliative care needs assessment tool (PC-NAT) in consultations with patients with advanced cancer and their caregivers, (2) potential of this tool to facilitate discussion of psychosocial issues, and (3) whether use of the tool alters the length of consultations. Design: A qualitative analysis was undertaken of audio-taped, outpatient consultations. Sample and methods: 20 individuals with advanced cancer and their caregivers who participated in an interrupted time series study of the impact of the systematic utilization of the PC-NAT had a total of 48 consultations audio-taped. These included 13 baseline recordings where PC-NAT was not completed and 35 that included completion of the PC-NAT. Audio-tapes were coded and SPSS was used to calculate the impact of using the PC-NAT on consultation length. Findings: This study revealed that the administration of the PC-NAT was not optimal to identify and discuss psychosocial concerns. The PC-NAT was delivered without an explanation of the function of the assessment and in jargonistic terms, and tended not to be integrated into the consultation. The majority of the interactions' content related to physical health issues. The range of empathic responses given by the oncologist in regards to patient and caregiver concerns ranged from low (denial/ disconfirmation) to very high (confirmation), though codes " dismissing" or " denying" were mainly assigned to psychosocial concerns compared to medical ones. There was no significant increase in consultation time when the routine needs assessment was included. Conclusion and interpretation: Staff training to enhance understanding and facilitate the timely use of the PC-NAT is warranted as well as to enhance response to unmet needs as part of routine care needs assessment tool.