Proactive community support tailored to holistic needs: A cohort study

Abstract

BackgroundIt is increasingly internationally recognized that a cancer diagnosis impacts on people practically and financially as well as physically and psychologically. It is less clear what to do about this. This study introduces an original community service designed to mitigate this wider impact. Nonclinical “link officers” use holistic needs assessment (HNA) to help newly diagnosed people identify and quantify the severity of their physical, psychological, practical, financial, and social concerns. A care plan is then agreed, usually involving community interventions from partner agencies. Following intervention, assessment is repeated. The primary aim of this study was to establish whether there was a significant difference between initial assessment and follow‐up, postintervention. Secondary aim was to identify potential predictors of increased levels of concern at baseline and follow‐up.MethodPre‐ and postintervention observational cohort study. Paired t test examined the difference in mean (SD) concern severity between baseline and follow‐up. Multiple linear regression models were computed to hypothesize potential predictors of initial concern severity and severity change.ResultsThe service saw 2413 people 2014‐2017. Participants identified average 5.5 (4.7) concerns, financial concerns being most frequent. Mean severity at baseline was 7.12 (out of 10) (2.50), reducing to 3.83 (3.49) post‐treatment, paired t(4454) = 64.68, P < 0.0001, reduction of 3.31 (95% CI 3.21‐3.41). Factors associated with higher initial concern included unemployment and caring responsibilities. Unemployment was also associated with a smaller reduction of concern severity at follow‐up.ConclusionPatient level of concern went from a level associated with specialist referral to a much more manageable level. This original finding is internationally significant because it extends Khera et al's (2017) “provocative idea” that all patients should be screened for financial problems to show that they can be helped with all their concerns. This article describes a successful, transferable model of community care.

Meeting psychosocial needs to improve health: a prospective cohort study

“…line with previous findings [9]. Figure 3 shows the mean change in the different domains of the HNA.…”

“…This study has described a significant association between change in HNA score and self-reported health status. Following intervention from ICJ, mean HNA concern severity reduced from 6.4 [6.23-6.71] to 2.9 [2.66-3.13], consistent with the decrease seen in the wider ICJ population [9]. Concurrently, EQ-5D score increased from 0.45 [0.422-0.488] to 0.57 [0.547-0.604], while VAS scores increased from 49 [47.1-51.1] to 57 [54.9-58.9].…”

“…The service has supported approximately 4000 people since 2014 across a range of cancer types and stages and sociodemographic backgrounds [9]. However, the most common use of the service is from individuals with lung cancer, who are aged between 55 and 64 years and who live in areas of high deprivation, as measured by the Scottish Index of Multiple Deprivation (SIMD).…”

“…There is quantitative and qualitative evidence that this service generates positive outcomes for individuals [9,10]. Demonstrating a national commitment to this model of care in 2019, Macmillan Cancer Support (a UK charity) and the Scottish Government each pledged £9 million to ensure everyone diagnosed with cancer has a dedicated support worker.…”

Meeting Psychosocial Needs to Improve Health: A Prospective Cohort Study

“…The time between assessments ranged from 14 to 456 days, averaging 117 days (median 84). Between baseline and follow up, self reported severity of concern dropped, in line with previous ndings [9]. Figure 3 shows the mean change in the different domains of the HNA.…”