Comprehensive needs assessment tool in cancer (CNAT): the development and validation
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).
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.
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.
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.
KeywordsNeoplasms Cancer Needs assessment Validation
- 1.Boyle P, Levin B, World Health Organization (2008) World cancer report 2008. IARC Press, LyonGoogle Scholar
- 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
- 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
- 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
- 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.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
- 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
- 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.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.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
- 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
- 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.Strauss AL, Corbin J (1990) Basics of qualitative research: grounded theory procedures and techniques. Sage, Newbury ParkGoogle Scholar
- 40.Cull A, Sprangers M, Kristin B, Aaronson N, West K, Bottomley A (2002) EORTC quality of life group translation procedure. EORTC, BrusselsGoogle Scholar
- 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.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.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
- 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
- 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
- 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