Edinburgh Napier University

  Background/rationale or Objectives/purpose: International government and clinical policy recommends individuals affected by cancer should have all their needs assessed. Implementation of holistic needs assess-ments (HNA) is however heterogeneous, involving different assessors, assessment tools, location, stage and types of cancer. This systematic review and thematic synthesis is the first to answer Does the way in which HNA is implemented, impact on the outcomes?
Methodology or Methods: MEDLINE, AMED, CINAHL, PsycIN-FO and the Psychological and Behavioural Sciences Collection were searched (2000 - 2017). Search strategy ensured inclusion of interna-tional HNA tools and synonyms for ‘needs’.
Impact on practice or Results: Three researchers reviewed 828 stud-ies, 20 met the inclusion criteria and included randomised controlled trials (n = 4), findings of local service evaluations (n = 8) and feasibility studies (n = 8). Variability in tool, purpose, approach and assessor ac-tions were found. Implementation approaches that impact on outcomes are identified. Evidence on patient outcomes is diffuse and dominated by those of measurable interest to researchers.
Discussion or Conclusions: This significant review of global stud-ies proposes that pursuers of 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.