Assessment of hospitalised cancer patients' needs by the Needs Evaluation Questionnaire

Annals of Oncology 11: 31-37, 2000. © 2000 Khmer Academic Publishers. Primed in the Netherlands. Original article Assessment of hospitalised cancer patients' needs by the Needs Evaluation Questionnaire M. Tamburini,1 L. Gangeri,1 C. Brunelli,1 E. Beltrami,1 P. Boeri,1 C. Borreani,1 C. Fusco Karmann,2 M. Greco,1 G. Miccinesi,1 L. Murru1 & P. Trimigno1 'Psychology Division, Islituto Nazionale Tumori; 2 Italian League Against Cancer, Milan, Italy ity, structure validity and internal consistency of the questionnaire. The prevalence analysis showed that the most common Background: Cancer disease modifies the order and the nature needs were: 'more information about my future conditions' of needs connected with the state of health. The aim of this (74%); 'more information about my diagnosis' (56%); 'more study was to evaluate the informative, psychological, social information about the exams I am undergoing' (52%); 'more and practical needs of hospitalised cancer patients by means of explanations on treatments' (51%); 'to have a better dialogue the Needs Evaluation Questionnaire (NEQ), an instrument with clinicians' (57%); 'better services from the hospital' (bathdesigned concisely for the convenience of patients and medical rooms, meals, cleaning) (56%). staff. Conclusions: The NEQ, self-completed by patients, has Patients and methods: Different samples of consecutive proven to be a useful clinical tool for obtaining a systematic hospitalised cancer patients were involved in the various phases and undistorted overview of the principal needs with respect to of designing the instrument: 30 patients for items identifica- the state of health of patients. This instrument, which can also tion, 101 patients for completeness and acceptability evalua- be administered by persons not belonging to the health care tion, 423 patients for construct validity and prevalence of system such as volunteers, and inserted into the patients' needs; content and reliability analysis were performed on 2 hospital charts, could be used by the medical staff to identify subsamples of, respectively, 60 and 88 of the patients from the the real needs of patients at an early stage. last sample. Results: The validation analysis showed rather good reliabil- Key words: cancer patients, needs assessment, questionnaire Summary Cancer disease modifies the order and nature of needs (in the sense of subjective desire and a lack of something necessary) connected with the state of health. The evolution of the disease, and the continuous controls and therapeutic treatments can greatly influence some aspects of daily life, since they alter relationships with family members and friends, diminish working capacity and leisure activities, modify the patient's social role and threaten his confidence. Analysis of the literature points out that the needs of the cancer patient have different 'nuances' and different 'weights' according to the situation he is experiencing (hospitalisation, home treatment, first diagnosis phase, etc.). Moreover, particular conditions are associated with specific need categories: practical and physiological needs were reported principally when the patient returned home [1-8]. It was observed that the patients tend mainly to report unsatisfied needs when the disease or the treatment cause restrictions to their daily activities, in particular when their financial resources have been reduced so that they are compelled to ask for medical and public assistance and when they are assisted by people not belonging to their own families [9]. The informative needs are mainly recognised during the diagnostic and decisional phase before treatment [1012], and when patients must undergo invasive surgical treatments or medical treatments with important side effects that cause a change in their life style as well as a modified image of their body [13-19]. The need of psychosocial support appears more often when the patient perceives the situation difficult to control for physical or emotional reasons [20-26]. Regarding needs assessment, it is important to make a subjective survey, that is, to report the needs expressed directly by the patient. This arises from observation of a discrepancy between the needs perception of staff and patients. It was observed that the nurses tended to attribute to the patient needs primarily of a psychological origin, overestimating their anxiety, hostility and depression levels, while the patients tended to highlight needs of physical origin. Moreover, a difference in perception of dissatisfaction concerning personal hygiene, diet, defecation, activities and rest was noted. In general, patients perceived major deficiencies for needs categories that included physical problems, while nurses underscored mainly psycho-social problems [6, 27]. Introduction 32 We believe that the use of a self-completed questionnaire should help in the clinical encounter to obtain a systematic and undistorted view of the principal needs linked to the state of health of the patient. This instrument, administered by non-members of the health care system such as volunteers, and inserted into the patients' hospital charts, could be used by the medical staff to identify at an early stage the patients' real needs. This modality of needs collection acknowledges the central position of the patient with respect to his condition of disease and aims to increase the patient's opportunities to express his own requirements and his own discomfort. On the basis of these considerations, in 1997 a new project was begun which aimed at analysing and evaluating the needs expressed by hospitalised cancer patients and which led to realisation of the instrument which is the object of this study. tions and then recording the relative answers. In this phase the feasibility of a procedure for the systematic survey in a ward was evaluated. Information relative to further difficulties in completing the questionnaire was registered, as well as the time of completion and the necessity of being helped or not by a member of the patient's family or by a volunteer. The results of this phase have not shown problems related to comprehensibility and acceptability: a median completion time of five minutes was required and 63% of the patients declared that they had been pleased with the questionnaire. Three further items were eliminated. Two of them: 'I need to maintain fully my activity' and 'I need not to feel dependent on others' were recognised as obvious and taken for granted. The third one 'I need to be more in contact with my family doctor' was eliminated because it could not be satisfied inside the hospital. This second version of the questionnaire, consisting of 25 items, was administered by the same procedures as the previous phases to a sample of 392 patients who were in the same surgical ward. Patients and methods The Needs Evaluation Questionnaire (NEQ) design The first NEQ design phase was based on semi-structured encount (...truncated)