Authors (including presenting author) :
LAU CM, LEE PC, CHAN SC, LAU MK, LEUNG WY, LEE MH, CHAN MK, NG LK
Affiliation :
Department of Surgery, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
Breast cancer patients face challenges throughout the journey of diagnosis, treatment, post-treatment, and recovery in their entire life. They also exposed to a multidisciplinary team including doctors, nurses, social workers, physiotherapists and psychologists who aim to address multiple concerns in breast cancer care. As every patient is different, cancer care needs to be tailored made based on a Holistic Needs Assessment (HNA) which assessing the needs for physical, practical, family, spiritual and emotional support of these patients. HNA helps breast cancer patients to realize their concerns are worthy of consideration and not unusual. It opens the door for discussion and enables patients to seek help at an earlier stage.
Therefore, HNA plays a vital role for realizing breast cancer patients’ concerns and helping multidisciplinary team to formulate patient-centered care plan and work more efficiently and effectively. As a result, improving the quality of life in their cancer journey could be achieved.
Objectives :
Provide a standard assessment tool for addressing the concerns of breast patients during their cancer journey.
Provide a holistic approach and identify stressors affecting the health of breast cancer patient.
Tailor make patient-centered care plan of individual patient.
Improve quality of care for breast cancer patients.
Methodology :
Set up a workgroup among breast cancer nurses. (Apr, 2019)
Review literatures on the needs of breast cancer patients. (Apr, 2019)
Modify the “Holistic Need Assessment Form” from Royal Free Hospital. (May, 2019)
Design patient opinion survey & staff satisfaction survey for the program. (May, 2019)
Test the effectiveness of the modified “Holistic Need Assessment Form”. (Jun, 2019)
Collect feedback from nurses and patients and make adjustment. (Jul, 2019)
Implement the program. (Aug, 2019 - Oct, 2021)
Evaluate the program. (Nov, 2021)
Result & Outcome :
There are total 92 patients and 20 nurses participated in the program.
1.The distress level of patient (NCCN Distress Level for Cancer Patients)
After the program, moderate distress level (scored ≥5) has been reduced from 73% to 41% . For extreme distress patients with scored ≥7 has been greatly decreased to 13%.
2.Five aspects of patient concerns (including practical concern, family concern, emotional concern, spiritual concern and physical concern.)
After the program, 78% patients concerned about practical issue has been decreased to 46 %. While 69% patients worried about physical concern has been greatly reduced to 39%.
3. Patient Satisfaction Survey
All patients agreed and strongly agreed HNA can facilitate in expressing concerns. 99% patients agreed and strongly agreed nurse education and support can minimize distress. 96% patients agreed and strongly agreed cooperating with other health professionals can reduce stress and HNA can help to address concerns. 89% patients agreed and strongly agreed that overall management can relieve distress level. And 88% patients agreed and strongly agreed education leaflets and pamphlets can reduce distress.
4. Staff Satisfaction Survey
All nursing staff agreed and strongly agreed that the program can help to identify and monitor the stressors of patients, facilitate formulation of the nursing care plan and nursing management, provide a holistic approach and a standard tool for assessment as well as to enhance the quality of care during the cancer journey.
Conclusion
Both patients and nursing staff have shown positive to the modified HNA. Patients reduced their level of distress after the program.
The modified Holistic Need Assessment is effective to capture concerns and determine the best approaches for formulating individualized care plan and target support for breast cancer patients. As the result, to improve the quality of care in breast cancer journey.
The HNA is not a one-off exercise. Further consideration of HNA can be further carried out in survivorship or end of life care pathways.
