Background
Quality palliative care assists a person with a life-limiting illness to live as well as possible until death. [4,9] For people with dementia or at end-of-life, meeting their needs can improve their quality of life. [2-5] Needs assessment allows the responsible clinician to identify the areas that patients and their families consider important, assess and understand the goals of care, and prepare the patient and family in how to access help and support as it is required. Recognition of the individual needs of palliative care patients and their family members forms the basis of individualised care. [3-8]
Anticipatory medical care is an important component of palliative care particularly home-based or community palliative care. When a person is identified as being in the last few weeks or months of life, the approach to their care is primarily palliative and will include appropriate planning and anticipation of future care needs. This may include “preferred place of care”, out of hours support, and anticipatory prescribing. [10-14] Anticipatory medical care focuses on the medical and health-related needs and differs slightly from needs assessment. More can be read in Care Coordination, Managing Crises and Syringe Drivers.
Evidence Summary
Older and/or frail adults have complex and changing needs and may require a range of services provided over an extended period. [8] Comprehensive multi-disciplinary geriatric assessment (CGA) can be used to plan appropriate and coordinated care relevant to identified needs. [8]
In Australia, and many other parts of the world, the demand for palliative care services is increasing due to the ageing of the population and the increase in the prevalence of cancer and other chronic diseases that accompany ageing. [1] People living with advanced cancer may need relevant and easy-to-understand information about anxiety, fatigue, pain management, and how to adapt to loss of functioning. [7]
Needs of carer may also need to be considered. You can find out more on the Family Carers pages.
Best-practice suggests that needs assessment forms an important part of palliative care in all settings. [4] Assessing and addressing psychosocial, spiritual and supportive care needs is an important component of comprehensive and holistic palliative care. [5,6] Evidence suggests that home-based palliative care often meets the physical needs of patients and their carers. [15] However, spiritual and psychosocial concerns are often inadequately addressed. [15] You can read about Spiritual Care as a distinct topic.
Palliative Care Needs Assessment (Ireland, 2014) tool comprises questions related to four domains of well-being: physical, social and occupational, psychological, and spiritual. [4] A health professional competent in the conduct of the assessment can use this series of questions to identify needs (identified or anticipated) to plan care or to refer a client to specialist palliative care. [4] It is recommended that a needs assessment be conducted at diagnosis of a life-limiting condition, at times of significant change (significant decline or deterioration, or change in family/social support or in functional status), at the request of the family or at end-of-life. [4] This tool is not specific for older adults.
The EASY-care tool is a comprehensive geriatric assessment (CGA) designed for assessing the unmet health and social needs of older people living in the community. [16] There is strong evidence for the validity and acceptability of EASY-Care as a personal needs assessment. [16] The tool has good acceptability internationally yet evidence is limited for the tool’s reliability, for its use as a population-level needs assessment or as a diagnostic tool for frailty. [16]
A significant proportion of older people in developed countries will spend the last year of their life in poor health (co-morbid conditions and/or frailty) and perhaps in social isolation. [17] An increasing number of older adults needing palliative care will live alone and wish to remain at home. [17] Informal support networks, technical aides and needs-based services form part of the emerging research investigating ways to allow older people at end-of-life to be cared for and to die at home, with optimal quality of life and minimal hospitalisations. [17]
It is suggested that embedding palliative care expertise in a rural community can best meet the palliative care needs of adults in that setting. [18] This requires educational programs and community support, and can be assisted by telehealth. [18] Geographic distance and costs are commonly noted as barriers. [18]
A needs assessment can be a systematic method of identifying unmet health and healthcare needs of a population. [19] In determining priorities for addressing the identified needs, it considers what should be done, what can be done, and what can be afforded. [19] A national health needs assessment for palliative care has been published in New Zealand. [20,21] In Australia, a needs assessment guide has been published but it relates to general medical services and is not specific to palliative care. [19] Aged care is one of the six key priorities for targeted work. [19]
Quality Statement
The quality of the included papers is acceptable. There is very little literature on the topic of needs assessments in palliative care for older people. Several papers addressed needs assessment in palliative care for a general adult population. [3-7,15,17-21] Papers focussing on needs assessment for older adults were not specific to palliative care. [2,8,16] Other literature was included to give context to this topic. [1,9-14] Guidelines for needs assessment in palliative care were published in New Zealand. [20,21]
Page created 08 February 2018