The goal of palliative care is to relieve the suffering of people affected by life-limiting illness through the comprehensive assessment and treatment of the physical, psychosocial and spiritual symptoms. Symptoms often follow a predictable pattern as the person progresses along their illness trajectory. Each person will experience these symptoms differently and will have different preferences for treatment and management.
Needs assessment tools assist in determining the support required and management responses. They can also elicit an understanding of the person’s preferences and priorities for care planning purposes. Needs assessments help determine the level of palliative care that a person requires at the current point in their illness trajectory.[4, 5]
Key assessment tools:
- Needs Assessment Tool for Progressive Disease – Cancer
Enables comprehensive screening of the need for referral to palliative care.
- Needs Assessment Tool: Progressive Disease (NAT-PD)
Assists in matching the types and levels of need experienced by people with progressive chronic diseases (eg, cancer, heart failure, COPD) and their caregivers with the most appropriate people or services to address those needs.
- Modified Karnofsky scale
Used to assess performance state and prognosis in advanced illnesses.
- PEPSICOLA aide memoire
A palliative care monthly review checklist from Gold Standards Framework website.
- Pain – Numeric Rating Scale
A simple validated pain assessment tool. From the Cancer Pain Management Wiki.
- Symptom review – SAS
The standard symptom assessment tool used in Australian palliative care services. Assesses seven core symptoms.
- Carer Support Needs Assessment Tool (CSNAT)
The CSNAT is an evidence-based tool that facilitates tailored support for family members and friends (carers) of adults with life-limiting illnesses. The research underpinning this tool was informed by carers and practitioners.
The person with a life-limiting illness, their family and carers should be actively involved in the initial and ongoing assessment of needs. This person-centred assessment focuses on holistic needs including:[6-10]
- Management of physical symptoms such as pain, weakness, fatigue and dyspnoea
- Management of psychological symptoms
- Need for social support
- Culturally specific needs related to language requirements and information disclosure preferences
- Need for information about treatment, diagnosis or prognosis
- Spiritual and existential concerns including hope, loss of meaning and uncertainty
- Financial concerns such as loss of income and medical costs
- Legal concerns such as preferences for end-of-life care and advance care directives.
These needs change over time and reassessment is required. For further information refer to Module 3 – Assessing and managing symptoms.
Consider William and how his needs have changed throughout his illness.
It has been one year since William’s colonoscopy showed he had stage III colorectal cancer, indicating regional lymph node involvement. Over the past year, he had a colon resection and six months of adjuvant chemotherapy. He has been seeing his GP every two months and has been attending the outpatient colorectal clinic every six months for follow up.
On his 12-month follow up, liver metastases were found. His cancer is now considered stage IV colorectal cancer. Palliative chemotherapy is available in some situations to control such advanced illness. However, William has worsening liver function and is physically too unwell to tolerate chemotherapy.
The surgeon has indicated to William that his prognosis is poor. William and his wife Gladys are seeing his GP to discuss what the oncologist from the colorectal clinic has recommended.
For further information about Colorectal cancer, access the Clinical practice guidelines for the prevention, early detection and management of colorectal cancer.
- Think about the principles of palliative care that you’ve reviewed and how they can be applied to William’s situation.
- What are William’s and Gladys’ main concern at this time?
- How have William’s needs changed throughout his illness?
- What are the key messages the GP provides in relation to William’s future care?
- How did the GP communicate these messages?
- How could this interaction be improved to ensure that William and Gladys get optimal support and information about the role of palliative care?
- What are William’s and Gladys’ main concerns at this time?
- Why is it important to consider peoples’ preferences when identifying needs at end of life?
- Refer to the Needs Assessment Tool: Progressive Disease (NAT:PD). Describe:
- The key needs that are assessed
- How the tool can be used in practice.
- What are some of the physical, psychological and social changes that can make a person with a life-limiting illness feel a loss of control?
- What are the reasons that people often fear pain and other symptoms even when effective symptom management is available?
- Rome, R.B., et al., The Role of Palliative Care at the End of Life. The Ochsner Journal, 2011. 11(4): p. 348-352.
- Palliative Care Australia. National Palliative Care Standards. 2018; 5th Edition:[Available from: http://palliativecare.org.au/standards].
- Australian Commission on Safety and Quality in Health care, National Consensus Statement: essential elements for safe and high-quality end-of-life care. 2015, ACSQHC: Sydney.
- Advance Care Planning Australia. Advance Care Planning Australia. 2018 [cited 2018 March 20]; Available from: https://www.advancecareplanning.org.au/.
- Advance Care Planning Australia and Austin Health. What is advance care planning? 2016 [cited 2017 May 3]; Available from: https://static1.squarespace.com/static/588185f5ff7c50bd37534307/t/589cfb4dd482e9ffb14b85c5/1486682958637/ACP_Fact_sheets_for_patients_and_familys_type_logo.pdf.
- Waller, A., et al., Development of the Palliative Care Needs Assessment Tool (PC-NAT) for use by multi-disciplinary health professionals. Palliative Medicine, 2008. 22(8): p. 956-64.
- Palliative Care Australia. What is Palliative Care A4 Brochure. 2015 [cited 2019 January 23]; Available from: https://palliativecare.org.au/wp-content/uploads/dlm_uploads/2016/05/What-is-Palliative-Care-A4.pdf
- Palliative Care Australia. What is Palliative Care? 2015 [cited 2019 January 23]; Available from: https://palliativecare.org.au/what-is-palliative-care.
- Palliative Care Australia. Palliative Care Service Development Guidelines. 2018; Available from: http://palliativecare.org.au/quality.
- Therapeutic Guidelines Ltd, Overview of Palliative Care. 2018: Melbourne.