Supportive Care in Cancer

, Volume 19, Issue 12, pp 1957–1968 | Cite as

Comprehensive needs assessment tool in cancer (CNAT): the development and validation

  • Eun-Jung Shim
  • kyung-Sook Lee
  • Jong-Hyock Park
  • Jae-Hyun Park
Original Article

Abstract

Purpose

Needs assessment is an important step toward quality and patient-centered cancer care, as it identifies patient need, guiding evidence-based cancer care policy, and maximizing care outcome. This study reports on the development and validation of comprehensive needs assessment tool in cancer (CNAT).

Methods

The CNAT, 59-item needs assessment tool for cancer was developed and validated in a large scale multi-center survey involving 2,661 cancer patients in ten fairly distributed cancer centers throughout Korea.

Results

To ensure content validity of the CNAT, items were derived from major needs assessment tools and input from experts and patients. Exploratory factor analysis confirmed its construct validity and identified seven factors: health care staff, psychological problems, physical symptoms, information, social and religious/spiritual support, practical support, and hospital facilities/services. Cronbach’s alpha for the scale was 0.97, and for subscales, it varied from 0.80 to 0.97. Convergent validity was demonstrated by its significant association with the EQ5D. Patients with elevated stress, depressive episodes, or suicidal ideation reported a significantly higher level of psychological and overall need. Known-group validity was also supported by its ability to detect significant differences according to age, gender, education, insurance status, months since diagnosis, and non-surgical anticancer treatment. Needs differed according to SEER stage and cancer type: advanced stage and breast and lung cancer were associated with a greater level of need.

Conclusions

The CNAT constitutes a meaningful and valid response to the challenges of cancer care, enabling assessment of need in cancer with a comprehensive yet concise and psychometrically sound tool.

Keywords

Neoplasms Cancer Needs assessment Validation 

Supplementary material

520_2010_1037_MOESM1_ESM.doc (124 kb)
ESM 1(DOC 123 kb)

References

  1. 1.
    Boyle P, Levin B, World Health Organization (2008) World cancer report 2008. IARC Press, LyonGoogle Scholar
  2. 2.
    Kurtz ME, Kurtz JC, Stommel M, Given CW, Given B (1997) Loss of physical functioning among geriatric cancer patients: relationships to cancer site, treatment, comorbidity and age. Eur J Cancer 33(14):2352–2358. doi:S0959-8049(97)00323-7 PubMedCrossRefGoogle Scholar
  3. 3.
    Carlson LE, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L, MacRae JH, Martin M, Pelletier G, Robinson J, Simpson JS, Speca M, Tillotson L, Bultz BD (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90(12):2297–2304. doi:10.1038/sj.bjc.6601887 PubMedGoogle Scholar
  4. 4.
    Edwards B, Clarke V (2004) The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients’ illness characteristics on depression and anxiety. Psychooncology 13(8):562–576. doi:10.1002/pon.773 PubMedCrossRefGoogle Scholar
  5. 5.
    Park JH, Kim SG (2009) Effect of cancer diagnosis on patient employment status: a nationwide longitudinal study in korea. Psychooncology 18(7):691–699. doi:10.1002/pon.1452 PubMedCrossRefGoogle Scholar
  6. 6.
    Kim SG, Hahm MI, Choi KS, Seung NY, Shin HR, Park EC (2008) The economic burden of cancer in korea in 2002. Eur J Cancer Care (Engl) 17(2):136–144. doi:10.1111/j.1365-2354.2007.00818.x CrossRefGoogle Scholar
  7. 7.
    Richardson A, Sitzia J, Medina J, Richardson A (2005) Patients’ needs assessment tools in cancer care: principles and practice. King's College London, LondonGoogle Scholar
  8. 8.
    Wen KY, Gustafson DH (2004) Needs assessment for cancer patients and their families. Health Qual Life Outcomes 2:11. doi:10.1186/1477-7525-2-11 PubMedCrossRefGoogle Scholar
  9. 9.
    Sanders SL, Bantum EO, Owen JE, Thornton AA, Stanton AL (2009) Supportive care needs in patients with lung cancer. Psychooncology. doi:10.1002/pon.1577 Google Scholar
  10. 10.
    Walker MS, Ristvedt SL, Haughey BH (2003) Patient care in multidisciplinary cancer clinics: does attention to psychosocial needs predict patient satisfaction? Psychooncology 12(3):291–300. doi:10.1002/pon.651 PubMedCrossRefGoogle Scholar
  11. 11.
    Richardson A, Medina J, Brown V, Sitzia J (2007) Patients’ needs assessment in cancer care: a review of assessment tools. Support Care Cancer 15(10):1125–1144. doi:10.1007/s00520-006-0205-8 PubMedCrossRefGoogle Scholar
  12. 12.
    Bonevski B, Sanson-Fisher R, Girgis A, Burton L, Cook P, Boyes A (2000) Evaluation of an instrument to assess the needs of patients with cancer. Supportive care review group. Cancer 88(1):217–225. doi:10.1002/(SICI)1097-0142(20000101)88:1 < 217::AID-CNCR29 > 3.0.CO;2-Y PubMedCrossRefGoogle Scholar
  13. 13.
    Bunston T, Mings D, Laperriere N, Malcolm J, Williams D (1998) The impact of psychosocial need and needs resolution on quality of life in patients with brain tumors. Neurosurg Focus 4(6):e7. doi:040607 PubMedCrossRefGoogle Scholar
  14. 14.
    Sharpe L, Butow P, Smith C, McConnell D, Clarke S (2005) The relationship between available support, unmet needs and caregiver burden in patients with advanced cancer and their carers. Psychooncology 14(2):102–114. doi:10.1002/pon.825 PubMedCrossRefGoogle Scholar
  15. 15.
    Mellink WA, Dulmen AM, Wiggers T, Spreeuwenberg PM, Eggermont AM, Bensing JM (2003) Cancer patients seeking a second surgical opinion: results of a study on motives, needs, and expectations. J Clin Oncol 21(8):1492–1497. doi:10.1200/JCO.2003.12.058 PubMedCrossRefGoogle Scholar
  16. 16.
    Jordan J, Dowswell T, Harrison S, Lilford RJ, Mort M (1998) Health needs assessment. Whose priorities? Listening to users and the public. BMJ 316(7145):1668–1670PubMedCrossRefGoogle Scholar
  17. 17.
    Ross CK, Steward CA, Sinacore JM (1993) The importance of patient preferences in the measurement of health care satisfaction. Med Care 31(12):1138–1149PubMedCrossRefGoogle Scholar
  18. 18.
    Janse AJ, Gemke RJ, Uiterwaal CS, van der Tweel I, Kimpen JL, Sinnema G (2004) Quality of life: patients and doctors don’t always agree: a meta-analysis. J Clin Epidemiol 57(7):653–661. doi:10.1016/j.jclinepi.2003.11.013 PubMedCrossRefGoogle Scholar
  19. 19.
    Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Lo SK, Wain G (2007) The development and evaluation of a measure to assess cancer survivors’ unmet supportive care needs: the casun (cancer survivors’ unmet needs measure). Psychooncology 16(9):796–804. doi:10.1002/pon.1137 PubMedCrossRefGoogle Scholar
  20. 20.
    Rainbird KJ, Perkins JJ, Sanson-Fisher RW (2005) The needs assessment for advanced cancer patients (NA-ACP): a measure of the perceived needs of patients with advanced, incurable cancer. A study of validity, reliability and acceptability. Psychooncology 14(4):297–306. doi:10.1002/pon.845 PubMedCrossRefGoogle Scholar
  21. 21.
    Tamburini M, Gangeri L, Brunelli C, Beltrami E, Boeri P, Borreani C, Fusco Karmann C, Greco M, Miccinesi G, Murru L, Trimigno P (2000) Assessment of hospitalised cancer patients’ needs by the needs evaluation questionnaire. Ann Oncol 11(1):31–37PubMedCrossRefGoogle Scholar
  22. 22.
    Steinberg ML (2008) Inequity in cancer care: explanations and solutions for disparity. Semin Radiat Oncol 18(3):161–167. doi:10.1016/j.semradonc.2008.01.003 PubMedCrossRefGoogle Scholar
  23. 23.
    McIllmurray MB, Thomas C, Francis B, Morris S, Soothill K, Al-Hamad A (2001) The psychosocial needs of cancer patients: findings from an observational study. Eur J Cancer Care (Engl) 10(4):261–269CrossRefGoogle Scholar
  24. 24.
    Meraner V, Giesinger J, Kemmler G, Taucher S, Hubalek M, Weber B, Rumpold G, Sperner-Unterweger B, Holzner B (2009) Development of a screening tool for the identification of psychooncological treatment need in breast cancer patients. Psychooncology. doi:10.1002/pon.1480 PubMedGoogle Scholar
  25. 25.
    Wong RK, Franssen E, Szumacher E, Connolly R, Evans M, Page B, Chow E, Hayter C, Harth T, Andersson L, Pope J, Danjoux C (2002) What do patients living with advanced cancer and their carers want to know?—a needs assessment. Support Care Cancer 10(5):408–415. doi:10.1007/s00520-002-0354-3 PubMedCrossRefGoogle Scholar
  26. 26.
    Osse BH, Vernooij MJ, Schade E, Grol RP (2004) Towards a new clinical tool for needs assessment in the palliative care of cancer patients: the pnpc instrument. J Pain Symptom Manage 28(4):329–341. doi:10.1016/j.jpainsymman.2004.01.010 PubMedCrossRefGoogle Scholar
  27. 27.
    Nayfield SG, Ganz PA, Moinpour CM, Cella DF, Hailey BJ (1992) Report from a national cancer institute(USA) workshop on quality of life assessment in cancer clinical trials. Qual Life Res 1:203–120PubMedCrossRefGoogle Scholar
  28. 28.
    Osse BH, Vernooij-Dassen MJ, de Vree BP, Schade E, Grol RP (2000) Assessment of the need for palliative care as perceived by individual cancer patients and their families: a review of instruments for improving patient participation in palliative care. Cancer 88(4):900–911. doi:10.1002/(SICI)1097-0142(20000215)88:4 < 900::AID-CNCR22 > 3.0.CO;2-2 PubMedCrossRefGoogle Scholar
  29. 29.
    Blazeby J, Sprangers M, Cull A, Morgens G, Bottomley A (2002) EORTC quality of life study group guidelines for developing questionnaire modules (revised edition), 3rd edn. EORTC, BrusselsGoogle Scholar
  30. 30.
    Fortner B, Okon T, Schwartzberg L, Tauer K, Houts AC (2003) The cancer care monitor: psychometric content evaluation and pilot testing of a computer administered system for symptom screening and quality of life in adult cancer patients. J Pain Symptom Manage 26(6):1077–1092. doi:S0885392403004342 PubMedCrossRefGoogle Scholar
  31. 31.
    Devlen J, Maguire P, Phillips P, Crowther D (1987) Psychological problems associated with diagnosis and treatment of lymphomas. Ii: prospective study. Br Med J (Clin Res Ed) 295(6604):955–957CrossRefGoogle Scholar
  32. 32.
    Emanuel LL, Alpert HR, Emanuel EE (2001) Concise screening questions for clinical assessments of terminal care: the needs near the end-of-life care screening tool. J Palliat Med 4(4):465–474. doi:10.1089/109662101753381601 PubMedCrossRefGoogle Scholar
  33. 33.
    Romsaas EP, Juliani LM, Briggs AL, Wysocki G, Moorman J (1983) A method for assessing the rehabilitation needs of oncology outpatients. Oncol Nurs Forum 10(3):17–21PubMedGoogle Scholar
  34. 34.
    Coyle N, Goldstein ML, Passik S, Fishman B, Portenoy R (1996) Development and validation of a patient needs assessment tool (pnat) for oncology clinicians. Cancer Nurs 19(2):81–92PubMedCrossRefGoogle Scholar
  35. 35.
    Cull A, Stewart M, Altman DG (1995) Assessment of and intervention for psychosocial problems in routine oncology practice. Br J Cancer 72(1):229–235PubMedCrossRefGoogle Scholar
  36. 36.
    Ahmedzai SH, Payne SA, Bestall JC, Ahmed N, Dobson K, Clark D, et al (2004) Improving access to specialist palliative care: developing a screening measure to assess the distress caused by advanced illness that may require referral to specialist palliative care. In: Group SPCS (ed) University of Sheffield and Trent Palliative Care Center, Sheffield CityGoogle Scholar
  37. 37.
    Lidstone V, Butters E, Seed PT, Sinnott C, Beynon T, Richards M (2003) Symptoms and concerns amongst cancer outpatients: identifying the need for specialist palliative care. Palliat Med 17(7):588–595PubMedCrossRefGoogle Scholar
  38. 38.
    The Institute for Health Research LU (2001) What are the psychosocial needs of cancer patients and their main carers: a study of user experience of cancer services with particular reference to psychosocial need. Lancaster UniversityGoogle Scholar
  39. 39.
    Strauss AL, Corbin J (1990) Basics of qualitative research: grounded theory procedures and techniques. Sage, Newbury ParkGoogle Scholar
  40. 40.
    Cull A, Sprangers M, Kristin B, Aaronson N, West K, Bottomley A (2002) EORTC quality of life group translation procedure. EORTC, BrusselsGoogle Scholar
  41. 41.
    Kim MH, Cho YS, Uhm WS, Kim S, Bae SC (2005) Cross-cultural adaptation and validation of the korean version of the eq-5d in patients with rheumatic diseases. Qual Life Res 14(5):1401–1406PubMedCrossRefGoogle Scholar
  42. 42.
    Wang XS, Wang Y, Guo H, Mendoza TR, Hao XS, Cleeland CS (2004) Chinese version of the m. D. Anderson symptom inventory: validation and application of symptom measurement in cancer patients. Cancer 101(8):1890–1901. doi:10.1002/cncr.20448 PubMedCrossRefGoogle Scholar
  43. 43.
    Okuyama T, Akechi T, Yamashita H, Toyama T, Endo C, Sagawa R, Uchida M, Furukawa TA (2009) Reliability and validity of the Japanese version of the short-form supportive care needs survey questionnaire (SCNS-SF34-J). Psychooncology 18(9):1003–1010. doi:10.1002/pon.1482 PubMedCrossRefGoogle Scholar
  44. 44.
    Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P (2000) The unmet supportive care needs of patients with cancer. Supportive care review group. Cancer 88(1):226–237. doi:10.1002/(SICI)1097-0142(20000101)88:1 < 226::AID-CNCR30 > 3.0.CO;2-P PubMedCrossRefGoogle Scholar
  45. 45.
    Campbell HS, Sanson-Fisher R, Turner D, Hayward L, Wang XS, Taylor-Brown J (2010) Psychometric properties of cancer survivors' unmet needs survey. Support Care Cancer. doi:10.1007/s00520-009-0806-0
  46. 46.
    Snyder CF, Dy SM, Hendricks DE, Brahmer JR, Carducci MA, Wolff AC, Wu AW (2007) Asking the right questions: investigating needs assessments and health-related quality-of-life questionnaires for use in oncology clinical practice. Support Care Cancer 15(9):1075–1085. doi:10.1007/s00520-007-0223-1 PubMedCrossRefGoogle Scholar
  47. 47.
    Cossich T, Schofield P, McLachlan SA (2004) Validation of the cancer needs questionnaire (cnq) short-form version in an ambulatory cancer setting. Qual Life Res 13(7):1225–1233PubMedCrossRefGoogle Scholar
  48. 48.
    Osse BH, Vernooij-Dassen MJ, Schade E, Grol RP (2007) A practical instrument to explore patients’ needs in palliative care: the problems and needs in palliative care questionnaire short version. Palliat Med 21(5):391–399. doi:10.1177/0269216307078300 PubMedCrossRefGoogle Scholar
  49. 49.
    Barg FK, Cronholm PF, Straton JB, Keddem S, Knott K, Grater J, Houts P, Palmer SC (2007) Unmet psychosocial needs of Pennsylvanians with cancer: 1986–2005. Cancer 110(3):631–639. doi:10.1002/cncr.22820 PubMedCrossRefGoogle Scholar
  50. 50.
    Hodgkinson K, Butow P, Fuchs A, Hunt GE, Stenlake A, Hobbs KM, Brand A, Wain G (2007) Long-term survival from gynecologic cancer: psychosocial outcomes, supportive care needs and positive outcomes. Gynecol Oncol 104(2):381–389. doi:10.1016/j.ygyno.2006.08.036 PubMedCrossRefGoogle Scholar
  51. 51.
    Hwang SY, Park BW (2006) The perceived care needs of breast cancer patients in korea. Yonsei Med J 47(4):524–533. doi:200608524 PubMedCrossRefGoogle Scholar
  52. 52.
    Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psychooncology 10(1):19–28. doi:10.1002/1099-1611(200101/02)10:1 < 19::AID-PON501 > 3.0.CO;2-6 PubMedCrossRefGoogle Scholar
  53. 53.
    Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Wain G (2007) Breast cancer survivors’ supportive care needs 2–10 years after diagnosis. Support Care Cancer 15(5):515–523. doi:10.1007/s00520-006-0170-2 PubMedCrossRefGoogle Scholar
  54. 54.
    Whelan TJ, Mohide EA, Willan AR, Arnold A, Tew M, Sellick S, Gafni A, Levine MN (1997) The supportive care needs of newly diagnosed cancer patients attending a regional cancer center. Cancer 80(8):1518–1524. doi:10.1002/(SICI)1097-0142(19971015)80:8 < 1518::AID-CNCR21 > 3.0.CO;2-7 PubMedCrossRefGoogle Scholar
  55. 55.
    Minstrell M, Winzenberg T, Rankin N, Hughes C, Walker J (2008) Supportive care of rural women with breast cancer in tasmania, australia: changing needs over time. Psychooncology 17(1):58–65. doi:10.1002/pon.1174 PubMedCrossRefGoogle Scholar
  56. 56.
    Bredart A, Bouleuc C, Dolbeault S (2005) Doctor–patient communication and satisfaction with care in oncology. Curr Opin Oncol 17(4):351–354. doi:00001622-200507000-00007 PubMedCrossRefGoogle Scholar
  57. 57.
    Kim J, Hahm MI, Park EC, Park JH, Kim SE, Kim SG (2009) Economic burden of cancer in south korea for the year 2005. J Prev Med Public Health 42(3):190–198. doi:10.3961/jpmph.2009.42.3.190 PubMedCrossRefGoogle Scholar
  58. 58.
    Ream E, Quennell A, Fincham L, Faithfull S, Khoo V, Wilson-Barnett J, Richardson A (2008) Supportive care needs of men living with prostate cancer in england: a survey. Br J Cancer 98(12):1903–1909. doi:6604406 [pii] 10.1038/sj.bjc.6604406 PubMedCrossRefGoogle Scholar
  59. 59.
    Harrison JD, Young JM, Price MA, Butow PN, Solomon MJ (2009) What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer. doi:10.1007/s00520-009-0615-5
  60. 60.
    Mor V, Masterson-Allen S, Houts P, Siegel K (1992) The changing needs of patients with cancer at home. A longitudinal view. Cancer 69(3):829–838PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Eun-Jung Shim
    • 1
  • kyung-Sook Lee
    • 2
  • Jong-Hyock Park
    • 2
  • Jae-Hyun Park
    • 3
  1. 1.Department of PsychologyCatholic University of DaeguGyeongsan-siRepublic of Korea
  2. 2.Division of Cancer Policy and Management, National Cancer Control Research InstituteNational Cancer CenterGoyang-siRepublic of Korea
  3. 3.Department of Social and Preventive Medicine, Samsung Biomedical Research InstituteSungkyunkwan University College of MedicineSuwonRepublic of Korea

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