Facilitating needs based cancer care for people with a chronic disease: Evaluation of an intervention using a multi-centre interrupted time series design

Background: Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered, are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis. This paper presents a study designed to assess the feasibility and efficacy of an intervention to assist in the allocation of palliative care resources according to need, within the context of a population of people with advanced cancer. ---------- Methods/design: People with advanced cancer and their caregivers completed bi-monthly telephone interviews over a period of up to 18 months to assess unmet needs, anxiety and depression, quality of life, satisfaction with care and service utilisation. The intervention, introduced after at least two baseline phone interviews, involved a) training medical, nursing and allied health professionals at each recruitment site on the use of the Palliative Care Needs Assessment Guidelines and the Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C); b) health professionals completing the NAT: PD-C with participating patients approximately monthly for the rest of the study period. Changes in outcomes will be compared pre-and post-intervention.---------- Discussion: The study will determine whether the routine, systematic and regular use of the Guidelines and NAT: PD-C in a range of clinical settings is a feasible and effective strategy for facilitating the timely provision of needs based care

Psychometric properties of cancer survivors' unmet needs survey

Purpose: This study aims to develop a psychometrically rigorous instrument to measure the unmet needs of adult cancer survivors who are 1 to 5 years post-cancer diagnosis. “Unmet needs” distinguishes between problems which survivors experience and problems which they desire help in managing. Methods: The survey was developed from a comprehensive literature review, qualitative analysis of the six most important unmet needs of 71 cancer Survivors, review of the domains and items by survivors and experts, cognitive interviews and a pilot test of 100 survivors. A stratified random sample of 550 cancer survivors, selected from a population-based Cancer Registry, completed a mailed survey to establish reliability and validity. Results: The final 89-item Survivors Unmet Needs Survey (SUNS) has high acceptability, item test–retest reliability and internal consistency (Chronbach’s alpha 0.990), face, content and construct validity. Five subscales measure Emotional Health needs (33 items, 19.4% of variance), Access and Continuity of Care (22 items, 15.1%), Relationships (15 items, 12.1%), Financial Concerns (11 items, 10.3%) and Information needs (eight items, 8.1% of the variance). Conclusions: This instrument has strong psychometric properties and is useful for determining the prevalence and predictors of cancer survivors’ unmet needs across types of cancer, length of survivorship and sociodemographic characteristics. Use of the SUNS will enable more effective targeting of programmes and services and guide policy and health planning decisions. Relevance: This study is an important step toward evidencebased planning and management of problems which the growing survivor population requires assistance in managing

Training, development and learning

This chapter discusses and explores a number of critical issues related to training, development and learning (TDL). It does this by highlighting the differ­ences between the terms, reflecting on older, more classical approaches to training versus more contemporary and recent trends that are more situation­ or context-specific. Such context-specificity means that the older approaches to training, although useful, have to be rethought. More recent trends in global organizations such as technological advances, human expectations of what constitutes a valuable job, organizational expectations related to capabilities that match strategic business needs, and increased social interaction, have meant that the older approaches are now less valuable