Assessment of uptake of holistic needs assessment (HNA) in newly diagnosed lung cancer patients
Category: Diagnosis and Initial Needs
The problem identified
The lung CNS team experienced difficulty ensuring all newly diagnosed lung cancer patients are offered a HNA to discuss concerns and information needs as per guidance. We wished to establish if all newly diagnosed lung cancer patients are being offered a HNA and to assess the uptake within this group.
The intervention made to change the problem
An audit was undertaken alongside the specialist palliative care team for a three month period to identify all newly diagnosed lung cancer patients to see what proportion had been offered an HNA and what proportion accepted it. There were 78 patients in the sample, 31 male and 47 female, average age 72 years, age range of 47-87 years. 15 patients had been referred directly to the hospital palliative care team as inpatients and had their HNA done by them. Of the remaining 63 patients, 57 patients had contact with a Macmillan lung nurse specialist and 6 patients had no contact with a Macmillan lung nurse specialist or the palliative care team. Out of the 63 patients, 35 (56%) were offered a HNA, 15 accepted a HNA and 13 had a HNA delivered. 2 patients who accepted a HNA didn't have it delivered - as HNA appointment clashed with oncology centre appointment/patient passed away. There was no significant difference between males and females accepting/declining HNA.
How it changed my practice
Newly diagnosed lung cancer patients are identified from the x-ray meeting and MDT meeting. Following the rapid access clinic the three Macmillan lung CNSs' identify if any patients have not been offered an HNA.
Any patients not seen by lung CNS have a nurse-led telephone appointment arranged to be offered an HNA. Inpatients will be seen on the ward to offer an HNA.
We use the electronic HNA and are part of phase 2 of the eHNA project in conjunction with Macmillan cancer support. The use of the electronic HNA will make it much easier to assess data in the future to identify issues affecting patients and potential service needs. We also plan to obtain the patients views about this service.
Resource / Cost implications
There are cost implications for the clinic rooms for the HNA clinic. Both the HNA and telephone clinic will generate income for the Trust. The ipad has been provided by Macmillan cancer support as part of the eHNA project. The HNA clinic has been incorporated into lung CNS working week and job plans. All three Macmillan lung nurse specialists have monthly clinical supervision according to the guidelines.
References
Holistic NeedsAssessment for people with cancer - A practical guide for healthcare professionals,NHS National Cancer Action Team, June 2011; Guidelines for Holistic Needs Assessment of Adult Cancer Patients, Merseyside and Cheshire Cancer Network, November 2011.