Abstract
Macmillan Cancer Support UK have developed an electronic Holistic Needs Assessment (eHNA) to: (1) help people living with cancer express all their needs, (2) help those helping them better target support. eHNA consists of 48 items each ranked from zero (no problem) to 10. There has been no psychometric analysis of this tool and so its validity and reliability are untested. The aim of this study was to evaluate the psychometric properties of the eHNA by examining its construct validity. Objectives were to (a) test whether the eHNA measured holistic concerns and (b) analyse the factor structure of the eHNA. Objectives were achieved through a secondary analysis of 5421 responses to eHNA using concurrent application of Rasch analysis and principal component analysis. All the items bar one fit with the Rasch rating model and were equivalently important to people. Differential item functioning was evident according to whether people were described as curative or not. A 12-factor solution explained 46 % variance. Of this the emotional/spiritual factor explained the most variance accounting for 15 %. The eHNA was internally consistent and conceptually coherent with the construct of holistic needs assessment. Clinical focus is best directed to the individual items highlighted by the patient except where patients check too many problems for the clinician to accurately prioritise. In these cases only, the emotional/spiritual factor may help identify appropriate clinical action. Strengths and weaknesses of the analyses are discussed, particularly in relation to ‘at risk’ subsamples such as those classified as non-curative.
Highlights
Many cancer survivors have moderate to severe unmet needs, often as consequences of treatment (Carey et al 2012)
The most widely used tool was the distress thermometer (DT), developed primarily to help assess the psychological needs of people affected by cancer (Holland and Bultz 2007)
The DT was found to be limited in relation to articulating all the relevant holistic needs of people affected by cancer (Mitchell et al 2010)
Summary
Many cancer survivors have moderate to severe unmet needs, often as consequences of treatment (Carey et al 2012). Changing the way cancer survivors are supported remains an ongoing priority (Tavernier 2014). Much of this work has focused on better understanding and acting on people’s individual holistic needs (Rooney et al 2014), and various tools and strategies have been developed to facilitate this agenda (Henry et al 2014). The most widely used tool was the distress thermometer (DT), developed primarily to help assess the psychological needs of people affected by cancer (Holland and Bultz 2007). The DT was found to be limited in relation to articulating all the relevant holistic needs of people affected by cancer (Mitchell et al 2010). The need for Holistic needs assessment aims to:
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