Centre for Health Research

& Psycho-oncology (CHeRP)

Systematic assessment of
palliative care needs: Efficacy,
time, resource implications &
future directions
Afaf Girgis, Amy Waller & David Currow
on behalf of the Palliative Care Research Team

Centre for Health Research & Psycho-oncology (CHeRP)

Cancer Council NSW, University of Newcastle
and Hunter Medical Research Institute

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National Program Team

Centre for Health Research
& Psycho-oncology (CHeRP)

Prof Afaf Girgis, Centre for Health Research & Psycho-oncology (CHeRP), Cancer
Council NSW, University of Newcastle & Hunter Medical Research Institute

Amy Waller, Dr Claire Johnson, Emma Gorton, Christophe Lecathelanais, CHeRP

Prof David Currow, Department of Palliative and Supportive Services, Flinders

University

Professor Patsy Yates, Centre for Palliative Care Research and Education,
Queensland University of Technology

A/Professor Geoff Mitchell, Discipline of General Practice, University of Queensland

Professor Linda Kristjanson & Professor Patricia Davidson, Curtin University of

Technology

Professor Brian Kelly & Associate Professor David Sibbritt, University of Newcastle

Professor Martin Tattersall, Discipline of Medicine, University of Sydney

Acknowledgements
Centre for Health Research
& Psycho-oncology (CHeRP)

Funding:
Australian Government Department of Health &
Ageing
Cancer Council NSW
University of Newcastle & NHMRC PhD scholarship
for A Waller
Development and production of DVD:
Pam McLean Cancer Communication Centre, The
University of Sydney and Royal North Shore Hospital,
Sydney

Overview of Palliative Care

Program (2003-2009)

Centre for Health Research

& Psycho-oncology (CHeRP)

COMPLETED WORK (2003-2008)

Phase 1: National qualitative study - perceptions of palliative care, issues
surrounding referral in the Australian health care system. [PhD - Johnson]
Phase 2: National survey of doctors - current referral practices, predictors of
referral, prevalence of triggers precipitating referral for SPC. [PhD-Johnson]

Phase 3: Development of national Palliative Care Needs Assessment

Guidelines and a Needs Assessment Tool, to facilitate needs-based care and
enhance SPC resource utilisation.
Phase 4: Evaluation of the impact of the guidelines and tool on patient &
caregiver outcomes. [PhD - Waller]

WORK UNDERWAY IN 2009

Phase 5: Development of national dissemination plan and training packages
for referrers and palliative care services
Phase 6: Generalising the resources to non-cancer palliative populations (HF)

Centre for Health Research

& Psycho-oncology (CHeRP)

Overview of the Needs

Assessment Tool: Progressive
Disease - Cancer (NAT: PD-C)

NAT: PD-C
Centre for Health Research
& Psycho-oncology (CHeRP)

Operationalises the Guidelines

Aims to facilitate care based on types and
complexity of needs:
no problems and no need for services;
minor problems (ie, low need), which may be met
by their primary health professional;
medium to high needs and potentially require a
referral for full assessment by specialist services

Designed for ongoing use in both

generalist and specialist care settings

Centre for Health Research

& Psycho-oncology (CHeRP)

Centre for Health Research

& Psycho-oncology (CHeRP)

Centre for Health Research

& Psycho-oncology (CHeRP)

Centre for Health Research

& Psycho-oncology (CHeRP)

Centre for Health Research

& Psycho-oncology (CHeRP)

Reliability & Validity of the

NAT: PD-C
[POSTER 252 WALLER]

Validation in specialist
PC service

Centre for Health Research

& Psycho-oncology (CHeRP)

Setting & participants

50 people with advanced cancer recruited from
a specialist palliative care service (SPCS)
Charles Gairdner [Wendy Scott]

Procedure
SPCS staff member completed a NAT on
patient admission
Second staff member completed:
Second NAT on same patient on same day
Other validated measures as part of standard
practice (PCOC)

Validation - analysis

Centre for Health Research

& Psycho-oncology (CHeRP)

Inter-rater reliability
Did staff members respond in the same way to each
item in the NAT? [Kappa]
Validity
Did staff respond in the same way to items in the PCNAT and Problem Severity Scale (PCPSS) items that
assessed similar areas of concern? [Kappa]
Does the NAT changes in functional status item
correlate with scores from:
Resource utilisation groups Activities of Daily Living
(RUG-ADL)?
Australian Karnofsky Performance Scale (AKPS)?

Results: HPs rated most

NAT items similarly
Item

Centre for Health Research

& Psycho-oncology (CHeRP)

Severity of concern
%
agreed

PABAK

Patient wellbeing
Physical

50

54%

0.31

Daily living

50

72%

0.58

Psychological

48

67%

0.51

Information

48

52%

0.28

Spiritual

48

88%

0.76

Financial

49

73%

0.60

Social

50

68%

0.52

Ability of caregiver/family to care for the patient

Distress

44

48%

0.22

Physical care

45

60%

0.40

Coping

45

67%

0.51

Financial

44

77%

0.54

Information

44

68%

0.49

Relationships and functioning

42

72%

0.57

Physical & psychosocial

Wellbeing

41

59%

0.39

Bereavement

40

58%

0.37

Caregiver wellbeing

Kappa agreement range:

0-0.2 = poor
0.2-0.4 = fair
0.4-0.6 = moderate
0.6-0.8 = substantial
0.8-1.0 = almost perfect

Results: Comparable to
validated measures
Measures
NAT vs Problem Severity Score

Centre for Health Research

& Psycho-oncology (CHeRP)

%
agreed

NAT Physical symptoms & PCPSS Pain

48

65%

0.48 (moderate)

NAT Physical symptoms &

PCPSS Other symptoms

47

49%

0.24 (fair)

NAT Psychological and PCPSS Psychological

48

63%

0.45 (moderate)

NAT Caregiver wellbeing and PCPSS Family

41

61%

0.42 (moderate)

PC-NAT level of
concern

RUG-ADL
(r = 0.74)

PABAK

AKPS
(r = - 0.84)

Mean

SD

Mean

SD

None

22

4.18

0.85

21

72.86

11.02

Some

22

7.59

4.10

21

55.71

11.64

Significant

9.80

4.38

42

21.68

Centre for Health Research

& Psycho-oncology (CHeRP)

Completion rates,
impact on referrals, patient
outcomes & length of
consultation
[POSTER 251 WALLER]

Evaluation study methods

Centre for Health Research
& Psycho-oncology (CHeRP)

Setting & participants

195 patients with advanced cancer and 103 of their
caregivers from 3 cancer centres (haematology,
medical, radiation & gynae oncology)

Data collection:
Bi-monthly CATIs for up to 15 months
Audio-taped some consultations

Intervention:
Health professionals trained in the Guidelines and use
of the NAT: PD-C, 5-9 months after start of recruitment
NAT: PD-C completed for all participating patients
approx monthly, by oncologist, nurse, GP, PC service

NAT: PD-C completion rates

83% completion rate in oncology clinics
1+ unmet need recorded on 80% of NATs
Majority of concerns addressed within the current
care systems; referrals in <10% of cases

Centre for Health Research

& Psycho-oncology (CHeRP)

Impact on patient outcomes

Significant reduction in % of patients with unmet:
health system and information needs
patient care and support needs

Physical and daily living needs and QoL appear

to be better maintained following the intervention

Length of consultation
(min) when NAT: PD-C
completed vs not

Mean
(minutes)
Median
Range

Without NAT
(n=15)

With NAT
(n=33)

19.7
17.5
9.2 - 53.5

17.4
17.4
3.5 40.0

Centre for Health Research

& Psycho-oncology (CHeRP)

Conclusions
Centre for Health Research
& Psycho-oncology (CHeRP)

The NAT: PD-C:

Can be reliably completed by any HCP in specialist
and generalist settings
Can assist in identifying issues of concern, particularly
in areas that are not routinely well addressed in the
consultation (eg psychological, caregiver issues)
Use does not lengthen consultations
Has acceptable levels of reliability and validity
Can facilitate communication between HCPs in
different care settings, eg as discharge planning tool

Name changed to encourage use with ALL

patients with advanced cancer

Centre for Health Research

& Psycho-oncology (CHeRP)

National dissemination
during 2009

Dissemination of resources
Centre for Health Research
& Psycho-oncology (CHeRP)

Summary Guidelines and a pad of 50

NAT:PD-Cs mailed to 1000+ health
services throughout Australia
- 37% Community services (nursing care)
- 30% Cancer treatment centres
- 22% Community services providing PC nursing
- 11% Palliative care services
PCOC, PEPA, COGs local support

Can Meet Needs

Skills training workshops
Dates so far .
Location of workshop

Date of workshop

WA - Perth

29th September 2009

1st October 2009
2nd October 2009

NSW - Albury
NSW - Sydney

22nd October 2009

5th November 2009

VIC - Melbourne

28th October 2009

QLD - Brisbane

4th November 2009

5th November 2009

TAS - Launceston
TAS - Hobart

26th November 2009

27th November 2009

SA - Adelaide

3rd December 2009

Centre for Health Research

& Psycho-oncology (CHeRP)

Dissemination online
Electronic resources

Centre for Health Research

& Psycho-oncology (CHeRP)

GUIDELINES - http://www.newcastle.edu.au/
research-centre/cherp/professional resources/
needs-assessment.html

NAT: PD-C - http://www.newcastle.edu.au/

research-centre/cherp/professional-resources/
natpdc.html

Can Meet Needs online program (to come)

http://www.newcastle.edu.au/researchcentre/cherp/CanMeetNeeds

Cancer Learning; Caresearch

Medical Director ????

Watch this space .

Centre for Health Research

& Psycho-oncology (CHeRP)

Battery of Needs Assessment Tools:

Needs Assessment Tool: Progressive
Disease Heart Failure (NAT: PD-HF)
Needs Assessment Tool: Patients & Families
(NAT-P&F) (consumer version in testing
phase)
Needs Assessment Tool: Caregivers (NAT-C)
(caregiver version for GP intervention in
testing phase)