Holistic needs assessment in outpatient cancer care: a randomised controlled trial.
Austyn Snowden, Jenny Young, Denis Roberge, Stefano Schipani, Esther Murray, Claude Richard, Marie-Therese Lussier, Craig White
Author Information
Austyn Snowden: Edinburgh Napier University, School of Nursing Midwifery and Social Care, Edinburgh, UK a.snowden@napier.ac.uk. ORCID
Jenny Young: Edinburgh Napier University, School of Nursing Midwifery and Social Care, Edinburgh, UK.
Denis Roberge: Département de médecine de famille et de médecine d'urgence, University of Quebec in Montreal, Montreal, Quebec, Canada.
Stefano Schipani: Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK.
Esther Murray: Psychology, Beatson West of Scotland Cancer Centre, Glasgow, UK.
Claude Richard: MEDICODE, University of Quebec in Montreal, Montreal, Quebec, Canada.
Marie-Therese Lussier: Faculté de médecine - Département de médecine de famille et de médecine d'urgence, University of Montreal, Montreal, Quebec, Canada.
Craig White: School of Cancer Sciences, University of Glasgow, Glasgow, UK. ORCID
DESIGN: Analyst blinded, parallel, multi-centre, randomised controlled trial (RCT). PARTICIPANTS: People with confirmed diagnoses of cancer (head and neck, skin or colorectal) attending follow-up consultation 3 months post-treatment between 2015 and 2020. INTERVENTION: Holistic needs assessment (HNA) or care as usual during consultation. OBJECTIVE: To establish whether incorporating HNA into consultations would increase patient participation, shared decision making and postconsultation self-efficacy. OUTCOME MEASURES: Patient participation in the consultations examined was measured using (a) dialogue ratio (DR) and (b) the proportion of consultation initiated by patient. Shared decision making was measured with CollaboRATE and self-efficacy with Lorig Scale. Consultations were audio recorded and timed. RANDOMISATION: Block randomisation. BLINDING: Audio recording analyst was blinded to study group. RESULTS: 147 patients were randomised: 74 control versus 73 intervention. OUTCOME: No statistically significant differences were found between groups for DR, patient initiative, self-efficacy or shared decision making. Consultations were on average 1 min 46 s longer in the HNA group (respectively, 17 m 25 s vs 15 min 39 s). CONCLUSION: HNA did not change the amount of conversation initiated by the patient or the level of dialogue within the consultation. HNA did not change patient sense of collaboration or feelings of self-efficacy afterwards. HNA group raised more concerns and proportionally more emotional concerns, although their consultations took longer than treatment as usual. IMPLICATIONS FOR PRACTICE: This is the first RCT to test HNA in medically led outpatient settings. Results showed no difference in the way the consultations were structured or received. There is wider evidence to support the roll out of HNA as part of a proactive, multidisciplinary process, but this study did not support medical colleagues facilitating it. TRIAL REGISTRATION NUMBER: NCT02274701.
