Measuring the unmet supportive care needs of cancer support persons: the development of the Support Person's Unmet Needs Survey – short form

Few rigorous measures of unmet needs have been developed for cancer support persons. This study describes the development of a short version of the Support Person's Unmet Needs Survey (SPUNS). Cancer survivors [n = 1589, 612 (52%) men, mean age of 62.5 years, SD 11.5] 1–5 years post diagnosis and recruited through three Canadian population‐based cancer registries were asked to pass a survey package on to their principal support person. Surveys were returned by 1183 support persons. The survey included the long form of the SPUNS, which contains 78 items. Fifty‐two items were deleted using a combination of expert opinion and statistical criteria. Analysis of the remaining items revealed a five‐factor structure. The original factors were retained with the exception of a merging of the personal and emotional needs subscales. Cronbach's alpha co‐efficients for all subscales were ≥0.87, and intraclass correlation of domain scores of the short and long versions of the SPUNS were high. The SPUNS short form was able to discriminate between support persons of survivors who had (n = 147), and those who had not received treatment in the past month (n = 969). At just 26 items, it is likely to have strong clinical and research applicability.     

The met and unmet health care needs of adult survivors of childhood central nervous system tumors: a double-informant, population-based study

BACKGROUND:

The purpose of the current study was to examine the persistent health care needs (HCNs) of adult survivors of childhood central nervous system tumors.

METHODS:

In this population‐based study, 526 of 679 eligible survivors and 550 parents provided data. Survivors' HCNs were assessed using a questionnaire covering 4 domains: Medical Care, care coordination and communication (Care Coordination), Illness Education, and Psychosocial Services. Needs were categorized as no need, met need, and unmet need. Outcomes were analyzed specifically in relation to survivors' functional late effects as assessed using the Health Utilities Index Mark 2/3.

RESULTS:

Approximately 40% of survivors experienced their HCNs as exceeding the supposed general population average, and 41% had a current HCN that was unmet. The most common unmet need concerned the Psychosocial Services domain (reported by 40%), followed by a lack of Illness Education (35%), Care Coordination (22%), and Medical Care (15%). Survivors experiencing functional late effects had greater HCNs, and a greater percentage of unmet needs. Agreement between survivor‐reported and parent proxy‐reported HCNs was satisfactory, whereas agreement for survivors' unmet HCNs ranged from poor to satisfactory.

CONCLUSIONS:

Findings based on reliable double‐informant data demonstrated that a considerable percentage of adult survivors report unmet HCNs, with female sex, younger age at diagnosis, and indications of disability and poor health status comprising significant risk factors. Issues critical for improved, comprehensive, long‐term follow‐up care were identified. Addressing these issues adequately in clinical follow‐up extending into adulthood would likely improve the quality of comprehensive care for this patient group. Cancer 2011;. © 2011 American Cancer Society     

Predictors of change in unmet supportive care needs in cancer

Objective: Patient Reported Outcome (PRO) assessments can assist health professionals to tailor their health practices to the individual needs of patients and improve patient care over time. The present study assessed prospective predictors of unmet supportive care needs in cancer patients over a six‐month period. Methods: Participants were recruited from a regional cancer treatment centre in Australia and completed the Supportive Care Needs Survey (SCNS) at recruitment (n=439; 61.4% response rate) and six months follow‐up (n=396). Hierarchical logistic regression was used to identify predictors of change in unmet needs across each supportive care domain. Predictor variables were socio‐demographic, treatment and psychosocial factors including depression, anxiety, social support, and patient satisfaction. Results: Unmet needs were reported by approximately two‐thirds of patients at baseline and half of patients at six months follow‐up. Having unmet needs at baseline was the strongest predictor of unmet needs at six months. Longer time since diagnosis was a consistent predictor of greater unmet needs, associated with change in physical/daily living, psychological and health system and information unmet needs over time. By contrast, a complex relationship was found in that patient satisfaction, psychosocial and treatment characteristics predicted higher needs in some domains and lower needs in others. Conclusions: Unmet supportive care needs persist over time and psychological needs may emerge later in the illness continuum. Interventions to meet the needs of longer term cancer survivors are needed and should closely articulate with reported supportive care needs. Copyright © 2009 John Wiley & Sons, Ltd.     

Psychometric properties of the Dutch extended Cancer Survivors’ Unmet Needs measure (CaSUN‐NL)

Information and support needs increase emotional distress and can impede cancer survivors’ adjustment. To investigate the information and support needs of Dutch cancer survivors, the Cancer Survivors’ Unmet Needs measure (CaSUN) was translated into Dutch and applied in two Dutch studies with cancer survivors (N = 255; N = 467). The CaSUN‐NL entailed the original five CaSUN scales, extended with respectively a returning to work and lifestyle scale. This study aimed to determine the psychometric properties of the CaSUN‐NL. To assess validity, a maximum likelihood factor analysis was employed. Construct validity was analysed using Pearson's and Spearman's correlation coefficients. To assess reliability, test–retest (Kappa coefficient) and internal consistency (Cronbach's alpha) values were determined. Factor analysis revealed the original five factors. Test–retest reliability was low (r ≤ .15, 93% retest response). Internal consistency values were high (Cronbach's alpha = 0.92–0.94), except for lifestyle. Significant correlations were found between total number of unmet needs with anxiety (r = .55), depression (r = .49), negative adjustment (r = .50), quality of life (r = ?.52) and age (r = ?.24). The CaSUN‐NL is valid and reliable to investigate the unmet information and support needs of Dutch cancer survivors.     

Validation of the Chinese version of the short-form Supportive Care Needs Survey Questionnaire (SCNS-SF34-C)

Background: There is no instrument available in Chinese for assessing psychosocial needs. This study aimed to assess the validity and reliability of the Chinese version of the Supportive Care Needs Survey short form (SCNS‐SF34‐C) in Chinese women with breast cancer (BC). Methods: The Chinese version of the 34‐item SCNS‐SF34‐C, a self‐report measure for assessing psychosocial unmet needs, was administered to 348 Chinese women with BC at the outpatient oncology unit. Exploratory factor analysis (EFA) tested the factor structure. The internal consistency, convergent, divergent, and discriminant validity of the identified factor structure were assessed. Results: In contrast to the five‐factor structure identified in the original 34‐item SCNS‐SF34, our EFA produced a 33‐item solution accounting for 54% of score variance comprising four‐factors: (1) Health system, information, and patient support, (2) Psychological needs, (3) Physical and daily living, and (4) Sexuality needs. Separate dimensions for Health system and information, and the Patient care and support domains were not supported. Cronbach alphas ranged from 0.75 to 0.92. Correlations of psychological and physical symptom distress measures indicated acceptable convergent validity. No correlation with optimism and positive affect measures indicated divergent validity. Discriminant validity was demonstrated by effective differentiation between clinically distinct patient groups (no active treatment versus active treatment; advanced BC versus localized BC). Discussion: The Chinese version of the Supportive Care Needs Survey has suitable factor structure and psychometric properties for use in assessing psychosocial needs among Chinese women with BC. Further validation is needed for other cancer types. Copyright © 2010 John Wiley & Sons, Ltd.     

The next generation of the supportive care needs survey: a brief screening tool for administration in the clinical oncology setting

Objective: The short form of the Supportive Care Needs Survey (SCNS‐SF34) is a 34‐item instrument for assessing the perceived needs of people diagnosed with cancer. This research is aimed at developing a brief screening tool for administration to patients in the clinical setting, by identifying the minimum number and optimal combination of item(s) to measure each of the SCNS‐SF34 domains with high sensitivity and specificity. Methods: Secondary analyses were undertaken on data from 1458 patients at 12 major public cancer treatment centres in Australia; with a random sample of 67% (n = 977) of the patient records selected as the developmental sample for developing the screening tool, while the remaining 33% (n = 481) constituted the validation sample on which analyses were repeated. Five criteria were applied to identify the optimum subset of items for the screening tool. Where statistical results were very similar across candidate item/s, items deemed more clinically important were chosen. Results: Nine items were identified, which can be efficiently and reliably used as a brief screening tool (SCNS‐ST9). An overall comparison of the results on the SCNS‐ST9 with the original SCNS‐SF34 indicates that only 11% of people reporting at least one moderate/high need on any SCNS‐SF34 domain were missed as having a moderate/high need on the SCNS‐ST9. Conclusions: Our very brief screening tool can be implemented in a clinical setting to reliably screen for unmet needs among cancer patients, with considerable savings in time and expense, increasing its potential for wide‐scale adoption in clinical settings. Copyright © 2011 John Wiley & Sons, Ltd.     

Survivorship care needs among LGBT cancer survivors

Objective: To better understand survivorship care needs among LGBT cancer survivors. Design: We administered an anonymous online survey. Sample: LGBT cancer survivors living in the United States. Methods: Participants were recruited via the National LGBT Cancer Project. The survey measured sociodemographic characteristics, social support, posttraumatic stress, and survivorship care needs. Results: Approximately 72% of our 114 participants were cisgender male and 87% were white. Almost all participants reported at least some unmet survivorship care needs (73%), with over half of participants reporting unmet psychological and sexuality care needs. Participants who reported their oncologist was not LGBT-competent had greater unmet needs (t(82) = 2.5, p = 0.01) and greater posttraumatic stress (t(91) = 2.1, p = 0.035). Conclusions: LGBT cancer survivors have significant unmet survivorship care needs, and lack of oncologist LGBT-competence is associated with unmet needs. Implications for Psychosocial Providers: Our results suggest the need for LGBT competency training for providers.     

Prospective evaluation of unmet needs of rural and aboriginal cancer survivors in Northern British Columbia

Background

The unmet needs of cancer survivors in rural, remote, and aboriginal communities are largely unexplored. We explored potential differences between rural survivors (rss) in 4 general population (gp) and 4 First Nations (fn) communities.

Methods

We approached 4 gp and 4 fn rs communities to participate in a mixed-methods project. Participants completed the Hospital Anxiety and Depression Scale (hads) and the Survivor Unmet Needs Survey (suns) and provided demographic information. Each question on the suns can be scored from 0 to 4, with 0 representing “no unmet need” and 4 representing “very high unmet need.” A directed approach to content analysis of focus group and interview data was used to triangulate the hads and suns results.

Results

We prospectively accrued 23 fn rss and 56 gp rss for this study. More fn rss had borderline or abnormal anxiety (5% vs. 21%, p = 0.02). Compared with gp rss, fn rss had higher unmet needs scores in all categories: Information (2.29 vs. 0.8, p < 0.001), Work and Financial (1.66 vs. 0.5, p < 0.001), Access and Continuity of Health Care (1.83 vs. 0.44, p < 0.001), Coping and Sharing (2.22 vs. 0.62, p < 0.001), and Emotional (2.12 vs. 0.63, p < 0.001). The qualitative findings provided examples and insight into the unmet needs experienced by rss.

Conclusions

First Nations rss had significantly higher anxiety and unmet needs compared with their gp rs counterparts. In addition, different qualitative themes were identified in the groups. Our findings support the development of tailored approaches to survivorship for these populations.     

Identifying the most prevalent unmet needs of cancer survivors in Australia: A systematic review

Understanding the unmet needs of cancer survivors is crucial to inform health service planning and optimize survivorship care. This systematic review sought to identify the most prevalent unmet needs of cancer survivors in Australia, and to determine personal, disease, and treatment‐related variables correlated with unmet needs. Seventeen studies were included in the review. Substantial heterogeneity across the included studies precluded statistical pooling of the data; narrative synthesis and vote counting were used to synthesize results. Unmet needs were ranked by the number of endorsements (n) each item received. The most frequently reported unmet needs of Australian cancer survivors are for help with psychosocial issues, including fear of cancer recurrence (n = 14; 14–42%), uncertainty about the future (n = 9; 12–26%), worry about partners, friends, and families (n = 8; 12–26%), help to reduce stress (n = 8; 12–34%), and sexual changes (n = 7; 11–29%). Survivors also needed more help with physical issues, including fatigue (n = 7; 10–27%) and usual activities (n = 6; 13–27%), and expressed supportive care unmet needs, including for affordable hospital car parking (n = 7; 12–26%), information about available services (n = 7; 11–33%), and peer support (n = 6; 13–26%). Anxiety, depression, and lower overall and physical quality of life were significantly correlated with greater unmet needs, as were younger age and more advanced disease.     

The development of a comprehensive needs assessment tool for cancer-caregivers in patient-caregiver dyads

Objective: The assessment of a caregiver's needs is a critical step for determining appropriate support services, providing high quality care, and achieving caregiver satisfaction. However, a systematic assessment of family caregiver's needs is rarely practiced. This study reports the development and validation of a comprehensive needs assessment tool for cancer caregivers (CNAT‐C). Methods: Items of CNAT‐C were generated through literature review and refined through expert consultation and caregiver interview, and pilot test. Final 41‐item needs assessment tool for cancer was developed and validated in a large‐scale multi‐center survey involving 600 cancer patients‐family caregiver dyads in 10 cancer centers fairly distributed throughout Korea. Results: The content validity of CNAT‐C was established throughout the development process. Principal component analysis resulted in a seven‐factor structure explaining 66.4% of the total variance: (1) health and psychological problems (6 items), (2) family/social support (5 items), (3) health‐care staff (8 items), (4) information (8 items), (5) religious/spiritual support (2 items), (6) hospital facilities and services (6 items), and (7) practical support (6 items). The Cronbach alpha was 0.96 for the total scale, and those for the subscales ranged from 0.79 to 0.95. Caregiver needs were not highly correlated with patient needs when compared domain‐by‐domain. Known‐group validity was also supported by the tool's ability to detect significant differences according to various patient and caregiver characteristics. Conclusions: The CNAT‐C appears to be a valid and reliable measure to assess comprehensive and multidimensional needs in caregivers of cancer patients. Copyright © 2010 John Wiley & Sons, Ltd.     

Challenges and perceived unmet needs of Chinese migrants affected by cancer: Focus group findings

Objectives: Chinese migrant cancer survivors and carers face multiple barriers to accessing quality cancer information and support. This study aimed to explore the challenges and unmet needs experienced by the Australian Chinese community affected by cancer, and understand the contexts that hindered optimal care for this community.

Methods: Adult cancer survivors and carers, whose native language is Mandarin or Cantonese, were recruited through community cancer support organizations. Bilingual researchers conducted focus groups with participants in either Mandarin or Cantonese. Focus groups were audio-recorded, transcribed, translated into English and thematically analyzed using qualitative methods.

Findings: 62 Chinese-speaking participants (34 cancer survivors and 28 carers) participated in one of the eight focus groups conducted. The three main themes were (1) unmet information and support needs (trust, wellness, and rights); (2) barriers compounding unmet needs (language, health literacy, culture); and (3) participants’ recommendations regarding cancer information and support provision. Seven subthemes of unmet needs were also identified: Trust (e.g., communication barriers, health system barriers, comparison regarding the care received), wellness (e.g., cultural differences produce conflict on views about wellness, need for psychological, community, and spiritual support), and rights (e.g., low awareness of financial and legal assistance, other factors increasing or reducing vulnerability).

Conclusions: This study highlights the needs and provides new insights into the impact of language, culture and health literacy barriers on the unmet information and support needs of the Chinese community affected by cancer. The key findings will inform the development of culturally targeted information and support resources for this community.     

The development and evaluation of a measure to assess cancer survivors' unmet supportive care needs: the CaSUN (Cancer Survivors' Unmet Needs measure)

BACKGROUND: Many cancer survivors experience ongoing morbidity over the survivorship continuum and their supportive care needs have yet to be comprehensively assessed. METHODS: This study aimed to develop and empirically evaluate a self-report measure of cancer survivors' supportive care needs. In Phase I, questionnaire items were generated based upon previous qualitative research that identified both unique and shared needs in survivors and their partners; items were constructed into the Cancer Survivors' Unmet Needs measure (CaSUN). In Phase 2, the CaSUN was completed by 353 cancer survivors who had been diagnosed with cancer between 1 and 15 years earlier and were currently disease-free. RESULTS: After modification, the CaSUN included 35 unmet need items, 6 positive change items and an open-ended question. Good acceptability, internal consistency and validity were demonstrated, although test-retest reliability was low. Maximum likelihood factor analysis identified five discrete factors: Existential Survivorship, Comprehensive Care, Information, Quality of Life and Relationships. CONCLUSIONS: Preliminary data indicates that the CaSUN meets the majority of psychometric criteria for assessment measures, although its low test-retest reliability awaits further investigation. The CaSUN will facilitate the evaluation of supportive care services and generation of service delivery recommendations for cancer survivors.     

The course of anxiety,depression and unmet needs in survivors of diffuse large B cell lymphoma and multiple myeloma in the early survivorship period

Purpose

The purpose of the study is to examine the course of anxiety, depression and unmet needs in diffuse large B cell lymphoma (DLBCL) and multiple myeloma (MM) survivors in the first 2 years post diagnosis.

Methods

DLBCL and MM survivors, recruited through the Victorian Cancer Registry, completed two interviews approximately 7 and 15 months post diagnosis. Hospital Anxiety and Depression Scale (HADS) and Supportive Care Needs Survey (SCNS-SF34) were completed at both interviews. Primary outcomes were prevalence of anxiety, depression and unmet needs (any or moderate–high). Generalized estimating equation examined whether course of anxiety, depression and unmet needs differed between the two cancers.

Results

Overall, 236 DLBCL and 178 MM survivors completed both telephone interviews. Course of anxiety differed (p < 0.01) with rate increasing in DLBCL (14 to 22%) while remaining stable for MM (15 to 12%). Course of depression also differed (p < 0.01), decreasing for MM (22 to 12%) and remaining stable for DLBCL (15 to 16%) survivors. Change in unmet needs was generally similar for the two cancer groups, except for moderate to high psychological needs (p < 0.05).

Conclusions

Patterns of change in anxiety and depression in first 2 years post diagnosis differ for DLBCL and MM survivors.

Implications for cancer survivors

Studying psychological outcomes in mixed haematological cancer samples may be inappropriate, at least in the early survivorship phase. Separate studies of the experiences of people with the different haematological cancer subtypes are needed to ensure psychosocial and supportive care interventions are appropriate to the needs of individuals with different haematological cancers.

     

Relationship between survivorship care plans and unmet information needs,quality of life,satisfaction with care,and propensity to engage with,and attend,follow-up care

Background

The impact of survivorship care plans (SCPs) on the proximal and distal outcomes of adult and childhood cancer survivors, and parent proxies, is unclear. This study aimed to determine the relationship between SCP receipt and these outcomes.

Methods

A cross-sectional survey of adult and childhood cancer survivors (and parent proxies for survivors aged younger than 16 years) across Australia and New Zealand was conducted. Multivariate regression models were fitted to measure the impact of SCP receipt on proximal (unmet information needs and propensity to engage with, and attend, cancer-related follow-up care) and distal outcomes (quality of life and satisfaction with cancer-related follow-up care) with control for cancer history and sociodemographic factors.

Results

Of 1123 respondents, 499 were adult cancer survivors and 624 were childhood cancer survivors (including 222 parent proxies). We found that SCP receipt was predictive of greater attendance at, and awareness of, cancer-related follow-up care (adult: odds ratio [OR], 2.46; 95% CI, 1.18–5.12; OR, 2.38; 95% CI, 1.07–5.29; child/parent: OR, 2.61; 95% CI, 1.63–4.17; OR, 1.63; 95% CI, 1.06–2.50; respectively). SCP receipt also predicted fewer unmet information needs related to “follow-up care required” and “possible late effects” (adult: OR, 0.44; 95% CI, 0.20–0.96; OR, 0.29; 95% CI, 0.13–0.64; child/parent: OR, 0.46; 95% CI, 0.30–0.72; OR, 0.57; 95% CI, 0.38–0.85; respectively). In terms of distal outcomes, SCP receipt predicted a better global quality of life for adult cancer survivors (β, 0.08; 95% CI, −0.01–7.93), proxy-reported health-related quality of life (β, 0.15; 95% CI, 0.44–7.12), and satisfaction with follow-up care for childhood cancer survivors (OR, 2.93; 95% CI, 1.64–5.23).

Conclusions

Previous studies have shown little impact of SCPs on distal end points. Results suggest that SCPs may be beneficial to cancer survivors’ proximal and distal outcomes.     

The needs of patients with advanced, incurable cancer

Background:

Limited research has investigated the specific needs of patients with advanced incurable cancer. The aim of this study was to describe the prevalence of perceived needs among this population.

Methods:

Medical specialists from two regions in New South Wales, Australia, identified patients with advanced, incurable cancer, who were estimated to have a life expectancy of <2 years and were not receiving formal palliative care. Of the 418 eligible patients, 246 (59%) consented to participate. Consenting patients completed the Needs Assessment for Advanced Cancer Patients questionnaire, which has demonstrable validity and reliability. Patients'' perceived needs were assessed across the seven domains of the questionnaire: psychological, daily living, medical communication and information, symptom related, social, spiritual and financial needs.

Results:

Patients identified the greatest areas of need in relation to psychological and medical communication/information domains. Patients'' specific needs were highest in dealing with a lack of energy and tiredness, coping with fears about the cancer spreading, and coping with frustration at not being able to do the things they used to do.

Conclusion:

This study indicates that patients with advanced, incurable cancer have high levels of unmet needs, especially in relation to the areas of psychological and medical communication/information needs. The data have the potential to guide the development of interventions aimed at meeting the current unmet needs of patients with advanced, incurable cancer.     

The supportive care needs survey for partners and caregivers of cancer survivors: development and psychometric evaluation

Objective: Begin to test the psychometric properties of a measure designed to capture the multi‐dimensional supportive care needs of cancer caregivers: the Supportive Care Needs Survey—Partners and Caregivers (SCNS‐P&C). Methods: Draft SCNS‐P&C items were developed with reference to the literature and existing instruments and reviewed for face and content validity. The final SCNS‐P&C was then completed by 547 cancer caregivers. Psychometric analyses conducted included principal factor analysis, internal consistency, and construct validity through the known‐group approach. Results: Factor analysis revealed four domains of needs: Health Care Service Needs, Psychological and Emotional Needs, Work and Social Needs, and Information Needs, with Cronbach's α coefficients ranging from 0.88 to 0.94. Construct validity of the SCNS‐P&C was partially supported. Across all domains, individuals with anxiety or depression were more likely to report at least one unmet moderate or high need in comparison to non‐anxious or non‐depressed participants. A greater proportion of younger participants experienced at least one unmet moderate or high need within the Psychological and Emotional Needs and Work and Social Needs domains. Proportion of reported unmet needs varied across cancer types for the Health Care Service Needs and Information Needs domains. Conclusions: The SCNS‐P&C has the potential to comprehensively assess the range of caregivers' supportive care needs, across the illness trajectory. Analyses supported the tool's internal consistency and construct validity. The SCNS‐P&C can be used by researchers and clinicians to determine caregivers' unmet needs, prioritise health‐care resources, and tailor supportive cancer care services accordingly. Copyright © 2010 John Wiley & Sons, Ltd.     

Assessing unmet supportive care needs in partners of cancer survivors: the development and evaluation of the Cancer Survivors' Partners Unmet Needs measure (CaSPUN)

BACKGROUND: Partners of cancer patients typically provide the majority of patients' emotional and physical care. Partners may be profoundly affected by the cancer and may experience ongoing supportive care needs across the survivorship continuum. Research has been restricted by a lack of psychometrically evaluated measures and in this study, a self-report measure of partners' needs was developed and empirically evaluated. METHODS: Questionnaire items generated from a qualitative study were constructed into a 47- item unmet need measure (Cancer Survivors' Partners Unmet Needs measure, CaSPUN). The psychometric properties of the CaSPUN were evaluated in 212 partners of patients who had been diagnosed with cancer 1-11 years earlier and were currently disease-free. RESULTS: The CaSPUN was modified to include 35 unmet need items, 6 positive change items and an open ended item. The CaSPUN demonstrates a high level of acceptability, internal consistency and construct validity, although test-retest reliability was moderate. Factor analysis identified five discrete factors: (1) Relationships, (2) Information, (3) Partner Issues, (4) Comprehensive Care and (5) Emotional Support. CONCLUSIONS: The CaSPUN permits the identification of long-term supportive care needs in generic populations of cancer survivors' partners and will assist with the formulation of recommendations regarding required supportive care services.     

Needs regarding care and factors associated with unmet needs in disease-free survivors of surgically treated lung cancer

BackgroundTo evaluate the long-term needs of lung cancer survivors and to explore factors associated with unmet need.Patients and methodsWe recruited lung patients treated with curative surgery from 2001 through 2006 at two centers in Korea. Needs in the domains of information, supportive care, education and counseling, and socioeconomic support were measured. We selected the four most frequently reported items of unmet need among 19 items in four domains.ResultsThe most frequently reported unmet needs were Complementary and alternative medicine (CAM) and folk remedies (59.8%) in the Information domain, Counseling and treatment of depression and anxiety (63.5%) in the Supportive care domain, diet, exercise and weight control (55.1%) in the Education and counseling domain and Financial support (90.4%) in the socioeconomic support domain. Unmet needs for psychological treatment was significantly greater in participants who were employed (adjusted odds ratio [aOR], 2.25; 95% confidential interval [CI], 1.12 to 4.53). Unmet needs for diet, exercise and weight control were significantly greater in participants who had not received chemotherapy (aOR, 1.76; 95% CI, 1.09 to 2.85). Unmet need for financial support was greater in participants who were married (aOR, 4.14, 95%CI, 1.12 to 15.22) and those who had not received chemotherapy (aOR, 5.91, 95%CI, 1.91 to 18.31).ConclusionThere were substantial unmet needs for information regarding psychological support, education for diet and exercise, and financial support among lung cancer survivors.     

Physicians' Awareness of the Breast Cancer Survivors' Unmet Needs in Korea

PurposePhysicians'' awareness of their cancer patients'' unmet needs is an essential element for providing effective treatment. This study investigated the accuracy of physicians'' awareness of breast cancer survivors'' unmet needs in Korea.MethodsA cross-sectional interview survey was performed among 106 physicians and 320 Korean breast cancer survivors. The Comprehensive Needs Assessment Tool was administered to physicians and cancer survivors after obtaining their written informed consent to participate. Data were analyzed using t-test, analysis of variance, and multiple regression analysis.ResultsThe level of unmet needs was highest in the hospital service domain (mean ± standard deviation: 2.19 ± 0.82), and the top-ranked unmet need item was “wished my doctor to be easy, specific, and honest in his/her explanation” (2.44 ± 0.93). Higher unmet needs were correlated with the presence of a genetic counseling clinic. They were not associated with age, sex, marital status, religion, department, working period, type of institution, number of staff, and number of operations. In multiple regression analysis, the presence of a genetic counseling clinic was associated with a higher level of recognition for psychological problems, social support, hospital service, and information and education needs. Physicians overestimated breast cancer survivors'' unmet needs in all domains, compared to their self-reported unmet needs. The discordance in the perceived unmet needs was highest in the ‘family/personal relationship problems’ domain.ConclusionsPhysicians who treat Korean breast cancer survivors rated the level of unmet needs of breast cancer survivors as highest in the hospital service domain. The presence of a genetic counseling clinic in physicians'' institutions was associated with a higher perception of survivors'' unmet needs. Physicians overestimated the level of unmet needs in Korean breast cancer survivors. Efforts to reduce these discordances are needed to implement optimal survivorship care.     

Validity,reliability and clinical feasibility of a Needs Assessment Tool for people with progressive cancer

Background: Needs assessment is a valuable approach for determining the way health and social services allocate resources to people with cancer and their caregivers. Aim: To assess the reliability, validity and acceptability of a Needs Assessment Tool (NAT) in a palliative care clinical setting. Methods: Psychometric properties of the NAT were initially explored in a pilot study involving filmed simulated advanced cancer patient and caregiver consultations. Further testing was undertaken in a clinical setting to determine the inter‐rater reliability, validity and feasibility of the NAT. Results: The results of the pilot study suggested good reliability and acceptability in a simulated setting. Further testing indicated that the patient daily living item was positively correlated with the Resource Utilisation Groups—Activities of Daily Living ( r =0.74) and negatively correlated with the Australian Karnofsky Performance Scale ( r =?0.84). Prevalence‐ and bias‐adjusted kappa values also indicated adequate agreement between Palliative Care Problem Severity Score items and the patient physical item (0.48), psychological item (0.45) and caregiver well‐being item (0.42). Conclusions: Needs assessment not only facilitates the identification of people who have specific concerns or are dissatisfied with some aspect of their care, but also determines the person's desire for assistance and involvement with services. The NAT is a highly acceptable and efficient tool that can be used by health professionals with a range of clinical expertise to identify individuals' needs, thereby enabling a better match of interventions of specialist services more closely linked to needs. Copyright © 2009 John Wiley & Sons, Ltd.