A Pilot Randomized Controlled Trial of a Holistic Needs Assessment Questionnaire in a Supportive and Palliative Care Service

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• 作者：Nisar Ahmed ; BSc(Hons) ; MMedSci^a ; ^{n.ahmed@sheffield.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; Philippa Hughes ; BA(Hons) ; RGN ; PGCE ; MA^b ; Michelle Winslow ; BA(Hons) ; PCHE ; PhD^b ; Peter A. Bath ; BSc(Hons) ; MSc ; PhD^c ; Karen Collins ; BA(Hons) ; RGN ; PhD^d ; Bill Noble ; MBChB ; MD ; FRCP ; FRCGP^a
• 关键词：Palliative care ; holistic needs assessment questionnaire ; SPARC ; MYCAW ; EQ-5D ; PEI
• 刊名：Journal of Pain and Symptom Management
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：50
• 期：5
• 页码：587-598
• 全文大小：323 K

文摘

At present, there is no widely used systematic evidence-based holistic approach to assessment of patients' supportive and palliative care needs.

Objectives

To determine whether the use of a holistic needs assessment questionnaire, Sheffield Profile for Assessment and Referral for Care (SPARC), will lead to improved health care outcomes for patients referred to a palliative care service.

Methods

This was an open, pragmatic, randomized controlled trial. Patients (n = 182) referred to the palliative care service were randomized to receive SPARC at baseline (n = 87) or after a period of two weeks (waiting-list control n = 95). Primary outcome measure is the difference in score between Measure Yourself Concerns and Wellbeing (MYCAW) patient-nominated Concern 1 on the patient self-scoring visual analogue scale at baseline and the two-week follow-up. Secondary outcomes include difference in scores in the MYCAW, EuroQoL (EQ-5D), and Patient Enablement Instrument (PEI) scores at Weeks 2, 4, and 6.

Results

There was a significant association between change in MYCAW score and whether the patients were in the intervention or control group (蠂²_trend = 5.51; degrees of freedom = 1; P = 0.019). A higher proportion of patients in the control group had an improvement in MYCAW score from baseline to Week 2: control (34 of 70 [48.6%]) vs. intervention (19 of 66 [28.8%]). There were no significant differences (no detectable effect) between the control and intervention groups in the scores for EQ-5D and Patient Enablement Instrument at 2-, 4-, or 6-week follow-up.

Conclusion

This trial result identifies a potential negative effect of SPARC in specialist palliative care services, raising questions that standardized holistic needs assessment questionnaires may be counterproductive if not integrated with a clinical assessment that informs the care plan.