The significant unmet needs of cancer patients: probing psychosocial concerns

Abstract

'Significant unmet needs' are those needs that patients identify as both important and unsatisfied. In this article we ask whether the overall needs of cancer patients are actually being met. We believe that the range of unmet need, and the kinds of patients who are more likely to claim unmet need, should be carefully identified. The needs responses of a series of 295 cancer patients in a cross-sectional survey were analysed. The majority expressed the opinion that information and good relationships with health care professionals were important, and few expressed dissatisfaction with these aspects of need. Similarly, needs items about support from family and friends were largely rated as important and satisfied. For a sizeable minority of patients, items of significant unmet need cluster around aspects of managing daily life, emotions, and social identity. The distribution of significant unmet needs is not random but is more likely to be experienced by patients who are younger, have a long-standing illness or disability, do not own/have use of a car, and/or have no religious faith. Furthermore, significant unmet needs relate to patients' ability to talk freely to a carer about the cancer, the degree to which the cancer interferes with social activities, and whether financial difficulties are experienced. Most of the significant unmet need is beyond the remit of services primarily designed for the treatment of disease. We consider whether multidisciplinary cancer teams can be expected to deal with all aspects of the cancer experience.

Unmet psychosocial needs in haematological cancer: a systematic review

“…Six studies assessed need in participants who were at different timepoints in their experiences of cancer [6,[29][30][31][32][33][34]. Four of these six studies used the Patient Needs Inventory (PNI) to assess need in their samples [6,30,31,33,34].…”

“…Four of these six studies used the Patient Needs Inventory (PNI) to assess need in their samples [6,30,31,33,34]. In these, needs relating to healthcare professionals were ranked highly, with 94% and 88.8% of patients identifying confidence in healthcare professionals as being important to them [31,33]. Of the two papers that used measures other than the PNI, one used the Supportive Care Needs Survey (SCNS-SF34) [29] and the other the Patient Information Need Questionnaire (PINQ) [32].…”

“…Within those studies that assessed need using the PNI, unmet needs relating to health professionals were scored most highly with levels as high as 94% [6,30,31,33,34]. Information needs were also common [21,25,32,33], however, this may be due to the type of need that some studies assessed for.…”

Predictors of change in unmet supportive care needs in cancer

“…To date, younger age [7][8][9][10][11], living in rural areas [8,12], later stage disease [7,12,13], type of cancer treatment [8,9,12], time since diagnosis [11,14] and physical or mental quality of life [13,15] have been associated with greater unmet needs. However, while these predictors provide some insight into the patients at risk of higher unmet supportive care needs, many of these factors are not amenable to change and so cannot be targeted by support interventions.…”

Psychosocial interventions for patients with advanced cancer – a systematic review of the literature

“…Moreover, several studies (Slevin et al, 1996;Sanson-Fisher et al, 2000;Soothill et al, 2001) report that patients in an advanced stage of the disease have high levels of psychosocial needs that are not properly met. Professional caregivers appear to be selective in their receptiveness of patients' needs, focus on physical problems and to a much lesser extent on emotional problems and psychosocial needs.…”