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Helping patients to raise issues using an electronic needs assessment

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Nicola Easton vividly remembers the first time staff at her hospital used an electronic holistic needs assessment (eHNA) with a cancer patient. It was, she says, “a revelation”.

Macmillan electronic needs assessment

Macmillan electronic needs assessment

“The person had already finished their treatment and had seemed to be well supported,” remembers Ms Easton, quality and improvement lead in the cancer programme at Guy’s and St Thomas’ Foundation Trust. “But through the assessment this person identified so many concerns – appearance, getting back to work, changes in weight and so on.

“They broke down as, through the assessment, for the first time, they had raised these issues. There were a number of practical things that could then be addressed, and the patient telephoned the nurses the next day to thank them.”

”The patient telephoned the nurses the next day to thank them”

This story is one that highlights the wide-ranging impact of cancer. For the 2.5 million people in UK living with or beyond the disease, the effect is often not just physical or emotional – it can also be practical, financial, social and spiritual. The idea of the holistic needs assessment is to get a sense of those concerns, and tonthen be able to plan care more effectively.

Macmillan Cancer Support has supported use of the assessment since 2008, and is currently working with more than 70 cancer service providers across the UK to offer the eHNA.

The assessment simply involves patients filling in a brief questionnaire: the electronic version is on an iPad and can be completed in just a few minutes.

“It’s a really good prompt,” reports Tracey Colwell, a patient who used the eHNA during her treatment. “When you’re looking at the iPad, you can just click a box [showing what you are worried about] and they can go through it with you.”

She adds: “If you have personal problems, you know ‘if I tick that, we can talk about that’.”

Adrienne Burnyeat found something similar during her treatment. “[The assessment] took the burden out of having to remember everything, every single time,” she says. “It’s a good checklist. It normalised everything, so any area of your life that’s affected by the treatment is highlighted and can be addressed effectively.”

“The actual assessment takes five minutes, but the fundamental thing is the conversation that happens afterwards to talk through those concerns and to address them,” argues Ms Easton.

She admits some nurses get concerned about “opening a can of worms”, and worry they will not be able to address all the issues raised by a patient.

”It’s not for you to be able to solve everything there and then in that consultation”

“But it’s not for you to be able to solve everything there and then in that consultation,” she stresses. “It’s about knowing what those concerns are and then knowing who to signpost them to.”

She says the top concern is often “worry, fear and anxiety, which is completely natural”. Yet sometimes the post-assessment conversation itself is sufficient to allay those worries.

The electronic version of the Holistic Needs Assessment makes it possible to know with confidence the top concerns of patients with cancer. At Guy’s and St Thomas’, Ms Easton can analyse the data collected in multiple ways.

“You can look at the top concerns by age, by tumour type, by pathway point – are they on treatment? Have they finished treatment? So I can look at people’s concerns at the beginning of treatment, on treatment, at the end of treatment – and they change. They change from emotional concerns to physical concerns when they’re on treatment and so on.”

”It is also possible to understand what actions have been taken to address patients’ worries”

Crucially, it is also possible to understand what actions have been taken to address patients’ worries, and to get a sense of which services and support might be needed at which points.

“There are multiple things it’s possible to get from the assessment now that it’s electronic – you have this massive dataset that you would never get from paper,” explains Ms Easton. “It is an enormous resource in terms of the information it gives us.”

Of course it is also transforming care for people with cancer. Karen Green has been diagnosed with the condition twice. “The first time I didn’t know what to do or where to go. Had I had this assessment 10 years ago, I wouldn’t have had all the stress and worry I did,” she says. “It feels like somebody out there cares. I’m not just a medical case to be dealt with – I’m a human being.”

For more information on the eHNA, visit

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