Edinburgh Napier University

  Purpose: International government and clinical policy recommends people affected by cancer should have all their needs assessed. Implementation of holistic needs assessments (HNA) is however heterogeneous, involving different assessors, assessment tools, location, stage and types of cancer. This systematic review is the first to answer ‘Does the way in which HNAs are implemented affect outcomes?’
Method: MEDLINE, AMED, CINAHL, PsycINFO and the Psychological and Behavioural Sciences Collection were searched (2000-2017). Search strategy ensured inclusion of international HNA tools and synonyms for ‘needs’.
Results: Three researchers reviewed 828 studies independently; 20 met the inclusion criteria and included randomised controlled trials (n=4), reported findings of local service evaluations (n=8) and feasibility studies on the use of HNA (n=8). Variability in tool, purpose, approach and assessor actions were found. Implementation approaches that affect outcomes are identified. Evidence on patient outcomes is diffuse and dominated by those of measurable interest to researchers.
Conclusion: This significant review of global studies identifies that critical process outcomes of HNA are under-researched. It proposes that people investigating outcomes of HNA are looking in the wrong place for evidence. More fruitful areas of enquiry are those that re-establish the connection between actions and outcomes. Actions of
assessors are classified as detecting, dealing and directing and a typology of assessment for people affected by cancer is proposed. There is a need for researchers and practitioners to reconceptualise HNA as a means and not an end in itself. More realist evaluation and in-depth longitudinal research is recommended.