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Afaf Girgis, Amy Waller & David Currow on behalf of the
Palliative Care Research Team
Centre for Health Research & Psycho-oncology (CHeRP)Cancer
Council NSW, University of Newcastle
and Hunter Medical Research Institute
T he si tuation of M ount L ofty was found
f rom he nce and f rom some other cr oss
bearings, to be 34 59' south and 138 42'
east . No land was visible so far to the
north as whe re the tr ees appeare d above
the horizon, which showed the c oast t o
be ve ry low, and our soundings we re
fas t de cre asing.
From noon to six o'cloc k we r an thirty
miles to the nor thward, skirt ing a sandy
shore at the distance of f ive , and thence
to eight mi le s; the depth was the n 5
fathoms, and we droppe d the anchor upon
a bottom of sand, mixe d with pie ces of
de ad coral.
Flinders University
Systematic assessment of palliative care needs: Efficacy, time,
resource implications &
future directions
Centre for Health Research & Psycho-oncology (CHeRP)
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Centre for Health Research & Psycho-oncology (CHeRP)
National Program Team Prof Afaf Girgis, Centre for Health
Research & Psycho-oncology (CHeRP), Cancer
Council NSW, University of Newcastle & Hunter Medical
Research Institute
Amy Waller, Dr Claire Johnson, Emma Gorton, Christophe
Lecathelanais, CHeRP
Prof David Currow, Department of Palliative and Supportive
Services, Flinders University
Professor Patsy Yates, Centre for Palliative Care Research and
Education, Queensland University of Technology
A/Professor Geoff Mitchell, Discipline of General Practice,
University of Queensland
Professor Linda Kristjanson & Professor Patricia Davidson,
Curtin University of Technology
Professor Brian Kelly & Associate Professor David Sibbritt,
University of Newcastle
Professor Martin Tattersall, Discipline of Medicine, University
of Sydney
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Centre for Health Research & Psycho-oncology (CHeRP)
Funding: Australian Government Department of Health &
Ageing Cancer Council NSW University of Newcastle & NHMRC
PhD scholarship
for A Waller
Development and production of DVD: Pam McLean Cancer
Communication Centre, The
University of Sydney and Royal North Shore Hospital, Sydney
Acknowledgements
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Centre for Health Research & Psycho-oncology (CHeRP)
Overview of Palliative Care Program (2003-2009)COMPLETED WORK
(2003-2008) Phase 1: National qualitative study - perceptions of
palliative care, issues
surrounding referral in the Australian health care system. [PhD
- Johnson] Phase 2: National survey of doctors - current referral
practices, predictors of
referral, prevalence of triggers precipitating referral for SPC.
[PhD-Johnson]
Phase 3: Development of national Palliative Care Needs
Assessment Guidelines and a Needs Assessment Tool, to facilitate
needs-based care and enhance SPC resource utilisation.
Phase 4: Evaluation of the impact of the guidelines and tool on
patient & caregiver outcomes. [PhD - Waller]
WORK UNDERWAY IN 2009 Phase 5: Development of national
dissemination plan and training packages
for referrers and palliative care services Phase 6: Generalising
the resources to non-cancer palliative populations (HF)
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Centre for Health Research & Psycho-oncology (CHeRP)
Overview of the Needs Assessment Tool: Progressive Disease -
Cancer (NAT: PD-C)
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Centre for Health Research & Psycho-oncology (CHeRP)
NAT: PD-C
Operationalises the Guidelines
Aims to facilitate care based on types and complexity of needs:
no problems and no need for services; minor problems (ie, low
need), which may be met
by their primary health professional; medium to high needs and
potentially require a
referral for full assessment by specialist services
Designed for ongoing use in both generalist and specialist care
settings
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Centre for Health Research & Psycho-oncology (CHeRP)
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Centre for Health Research & Psycho-oncology (CHeRP)
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Centre for Health Research & Psycho-oncology (CHeRP)
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Centre for Health Research & Psycho-oncology (CHeRP)
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Centre for Health Research & Psycho-oncology (CHeRP)
Reliability & Validity of the NAT: PD-C
[POSTER 252 WALLER]
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Centre for Health Research & Psycho-oncology (CHeRP)
Setting & participants 50 people with advanced cancer
recruited from
a specialist palliative care service (SPCS) Charles Gairdner
[Wendy Scott]
Procedure SPCS staff member completed a NAT on
patient admission Second staff member completed:
Second NAT on same patient on same day Other validated measures
as part of standard
practice (PCOC)
Validation in specialist PC service
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Centre for Health Research & Psycho-oncology (CHeRP)
Validation - analysisInter-rater reliability Did staff members
respond in the same way to each
item in the NAT? [Kappa]
Validity Did staff respond in the same way to items in the
PC-
NAT and Problem Severity Scale (PCPSS) items that assessed
similar areas of concern? [Kappa]
Does the NAT changes in functional status item correlate with
scores from: Resource utilisation groups Activities of Daily
Living
(RUG-ADL)? Australian Karnofsky Performance Scale (AKPS)?
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Centre for Health Research & Psycho-oncology (CHeRP)
Results: HPs rated most NAT items similarly
Item N Severity of concern %
agreed PABAK
Patient wellbeing Physical 50 54% 0.31 Daily living 50 72% 0.58
Psychological 48 67% 0.51 Information 48 52% 0.28 Spiritual 48 88%
0.76 Financial 49 73% 0.60 Social 50 68% 0.52
Ability of caregiver/family to care for the patient Distress 44
48% 0.22 Physical care 45 60% 0.40 Coping 45 67% 0.51 Financial 44
77% 0.54 Information 44 68% 0.49 Relationships and functioning 42
72% 0.57 Caregiver wellbeing Physical & psychosocial
Wellbeing
41 59% 0.39
Bereavement 40 58% 0.37
Kappa agreement range:0-0.2 = poor0.2-0.4 = fair0.4-0.6 =
moderate0.6-0.8 = substantial 0.8-1.0 = almost perfect
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Centre for Health Research & Psycho-oncology (CHeRP)
Results: Comparable to validated measures
Measures NAT vs Problem Severity Score
N % agreed
PABAK
NAT Physical symptoms & PCPSS Pain 48 65% 0.48 (moderate)NAT
Physical symptoms & PCPSS Other symptoms
47 49% 0.24 (fair)
NAT Psychological and PCPSS Psychological 48 63% 0.45
(moderate)
NAT Caregiver wellbeing and PCPSS Family 41 61% 0.42
(moderate)
PC-NAT level of concern
RUG-ADL (r = 0.74)
AKPS(r = - 0.84)
N Mean SD N Mean SDNone 22 4.18 0.85 21 72.86 11.02Some 22 7.59
4.10 21 55.71 11.64
Significant 5 9.80 4.38 5 42 21.68
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Centre for Health Research & Psycho-oncology (CHeRP)
Completion rates, impact on referrals, patient
outcomes & length of consultation
[POSTER 251 WALLER]
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Centre for Health Research & Psycho-oncology (CHeRP)
Evaluation study methods Setting & participants
195 patients with advanced cancer and 103 of their caregivers
from 3 cancer centres (haematology, medical, radiation & gynae
oncology)
Data collection: Bi-monthly CATIs for up to 15 months
Audio-taped some consultations
Intervention: Health professionals trained in the Guidelines and
use
of the NAT: PD-C, 5-9 months after start of recruitment NAT:
PD-C completed for all participating patients
approx monthly, by oncologist, nurse, GP, PC service
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Centre for Health Research & Psycho-oncology (CHeRP)
NAT: PD-C completion rates 83% completion rate in oncology
clinics 1+ unmet need recorded on 80% of NATs Majority of concerns
addressed within the current
care systems; referrals in
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Centre for Health Research & Psycho-oncology (CHeRP)
Length of consultation (min) when NAT: PD-C completed vs not
Without NAT (n=15)
With NAT (n=33)
Mean (minutes) 19.7 17.4 Median 17.5 17.4 Range 9.2 - 53.5 3.5
40.0
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Centre for Health Research & Psycho-oncology (CHeRP)
Conclusions The NAT: PD-C:
Can be reliably completed by any HCP in specialist and
generalist settings
Can assist in identifying issues of concern, particularly in
areas that are not routinely well addressed in the consultation (eg
psychological, caregiver issues)
Use does not lengthen consultations Has acceptable levels of
reliability and validity Can facilitate communication between HCPs
in
different care settings, eg as discharge planning tool Name
changed to encourage use with ALL
patients with advanced cancer
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Centre for Health Research & Psycho-oncology (CHeRP)
National disseminationduring 2009
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Centre for Health Research & Psycho-oncology (CHeRP)
Dissemination of resources
Summary Guidelines and a pad of 50 NAT:PD-Cs mailed to 1000+
health services throughout Australia- 37% Community services
(nursing care)- 30% Cancer treatment centres- 22% Community
services providing PC nursing- 11% Palliative care services
PCOC, PEPA, COGs local support
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Centre for Health Research & Psycho-oncology (CHeRP)
Can Meet Needs Skills training workshopsDates so far .
Location of workshop Date of workshop WA - Perth 29th September
2009
1st October 20092nd October 2009
NSW - AlburyNSW - Sydney
22nd October 20095th November 2009
VIC - Melbourne 28th October 2009
QLD - Brisbane 4th November 20095th November 2009
TAS - LauncestonTAS - Hobart
26th November 200927th November 2009
SA - Adelaide 3rd December 2009
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Centre for Health Research & Psycho-oncology (CHeRP)
Dissemination online Electronic resources
GUIDELINES - http://www.newcastle.edu.au/
research-centre/cherp/professional resources/
needs-assessment.html
NAT: PD-C - http://www.newcastle.edu.au/
research-centre/cherp/professional-resources/ natpdc.html
Can Meet Needs online program (to come)
http://www.newcastle.edu.au/research-
centre/cherp/CanMeetNeeds
Cancer Learning; Caresearch Medical Director ????
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Centre for Health Research & Psycho-oncology (CHeRP)
Watch this space .
Battery of Needs Assessment Tools: Needs Assessment Tool:
Progressive
Disease Heart Failure (NAT: PD-HF) Needs Assessment Tool:
Patients & Families
(NAT-P&F) (consumer version in testing phase)
Needs Assessment Tool: Caregivers (NAT-C) (caregiver version for
GP intervention in testing phase)
Slide Number 1National Program Team AcknowledgementsOverview of
Palliative Care Program (2003-2009)Slide Number 5NAT: PD-CSlide
Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number
11Validation in specialist PC serviceValidation - analysisResults:
HPs rated most NAT items similarlyResults: Comparable to validated
measuresSlide Number 16Evaluation study methodsImpact on patient
outcomesLength of consultation (min) when NAT: PD-C completed vs
notConclusionsSlide Number 21Dissemination of resources Can Meet
Needs Skills training workshopsDissemination online Watch this
space .