Tools for guiding interventions to address patient-perceived multidimensional unmet healthcare needs in palliative care: systematic literature review

Abstract

ContextThe unmet needs of patients with advanced disease are indicative of the patient centredness of healthcare. By tracking unmet needs in clinical practice, palliative interventions are aligned with patient priorities, and clinicians receive support in intervention delivery decisions for patients with overlapping, complex needs.ObjectiveIdentify tools used in everyday clinical practice for the purpose of identifying and addressing unmet healthcare needs for patients with advanced disease.MethodsWe conducted PubMed and Cumulative Index of Nursing and Allied Health Literature searches to include studies published between 1 January 2008 and 21 April 2020. Three concepts were used in constructing a search statement: (1) patient need, (2) validated instrument and (3) clinical practice. 2313 citations were reviewed according to predefined eligibility, exclusion and inclusion criteria. Data were collected from 17 tools in order to understand how instruments assess unmet need, who is involved in tool completion, the psychometric validation conducted, the tool’s relationship to delivering defined palliative interventions, and the number of palliative care domains covered.ResultsThe majority of the 17 tools assessed unmet healthcare needs and had been validated. However, most did not link directly to clinical intervention, nor did they facilitate interaction between clinicians and patients to ensure a patient-reported view of unmet needs. Half of the tools reviewed covered ≤3 dimensions of palliative care. Of the 17 tools evaluated, 4 were compared in depth, but all were determined to be insufficient for the specific clinical applications sought in this research.ConclusionA new, validated tool is needed to track unmet healthcare needs and guide interventions for patients with advanced disease.

Development of a tool for palliative care needs assessment and intervention: mixed methods research at a Swiss tertiary oncology clinic

“…According to a literature review this research group conducted the topic, other tools in use with the palliative care patient population do not offer features that are completely comparable to our newly developed tool (22). In comparison with other tools, the tool developed through this research is unique in the following ways.…”

“…A clinical tool can give professionals a helpful framework for their clinical interactions, and it can give guidance to oncologists about when a referral to specialist palliative care is indicated. Our research team conducted a literature review of validated tools in use in palliative care (22), building upon the work of Carlson et al (23) and Moghaddam et al (24). Seventeen articles were reviewed in depth to identify a clinical tool that can screen for multidimensional unmet needs in palliative care patients.…”

“…Seventeen articles were reviewed in depth to identify a clinical tool that can screen for multidimensional unmet needs in palliative care patients. The review found no tools that matched the designated criteria (22).…”