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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. 1Clinic for Medical Oncology & Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
  2. 2Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
  3. 3School of Health Professions, Institute of Nursing, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
  4. 4Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland
  5. 5Integrated 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}uzh.ch

Abstract

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
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Footnotes

  • 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.

  • Patient consent for publication Not required.

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

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

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