Article Text

Download PDFPDF
Tools for guiding interventions to address patient-perceived multidimensional unmet healthcare needs in palliative care: systematic literature review
  1. Ellie B Schmidt1,2,
  2. David Blum2,
  3. Franzisca Domeisen Benedetti1,3,
  4. Mathias Schlögl2,4 and
  5. Florian Strasser1,5
  1. 1 Clinic for Medical Oncology & Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
  2. 2 Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
  3. 3 School of Health Professions, Institute of Nursing, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
  4. 4 Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland
  5. 5 Integrated Oncological Rehabiliation & Cancer Fatigue Clinic, Clinic Gais, Gais, Switzerland
  1. Correspondence to Ms Ellie B Schmidt, Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland; Ellie.Schmidt{at}


Context The 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.

Objective Identify tools used in everyday clinical practice for the purpose of identifying and addressing unmet healthcare needs for patients with advanced disease.

Methods We 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.

Results The 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.

Conclusion A new, validated tool is needed to track unmet healthcare needs and guide interventions for patients with advanced disease.

  • clinical assessment
  • symptoms and symptom management
  • home care
  • hospital care
  • prognosis
  • social care

Data availability statement

Data are available upon reasonable request. Please contact Ellie B. Schmidt to request data.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request. Please contact Ellie B. Schmidt to request data.

View Full Text


  • Correction notice This article has been updated since it was first published. The article type has been changed to Systematic review.

  • Contributors FS designed and directed the project. EBS and FDB performed data collection and analysis. MS and DB were methodological advisors. EBS, DB and MS wrote the manuscript in consultation with FS.

  • Funding This work was supported by the Swiss Academy of Medical Sciences Research Programme 'Research in Palliative Care' (project PC36/17).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.