CANAssess

What we did

We tested for inter-rater and test-retest reliability using video-recorded consultations with doctors and patients, using the NAT-C to guide the consultation. GPs and nurses watched the videos and completed the NAT-C tool.

What we found

55 GPs and seven nurses provided 121 assessments of the video-consultations using the NAT-C. There was at least fair reliability for all items in Section 2 in assessing patient wellbeing, with moderate inter-rater reliability for 2/6 items: daily activities (Kappa: 0.50) and psychological symptoms (Kappa: 0.46). For test-retest reliability, 21 GPs and six nurses undertook 46 re-tests. The results show at least moderate reliability for 5/6 patient wellbeing items and 5/5 for the ability of carer to care for patient.

What we did

We tested construct validity by comparing the NAT-C assessments from clinicians, with patient and carer-completed questionnaires to see how well the different domains were in agreement.

What we found

17 GPs completed at least one NAT-C assessment with a patient. Thirty-nine people with advanced cancer participated. The NAT-C has at least fair agreement for 5/6 the patient wellbeing domains. There was high moderate agreement for daily living and the Resource Utilisation Groups Activities of Daily Living (RUG-ADL) total score.

Publications

Allgar VL, Chen H, Richfield E, Currow D, Macleod U, Johnson MJ. Psychometric Properties of the Needs Assessment Tool-Progressive Disease Cancer in U.K. Primary Care. J Pain Symptom Manage.

Testing the effectiveness and cost-effectiveness of the NAT-C in a main trial

What we did

The CANAssess research team tested the NAT-C in a larger trial to see if the consultation guide could help reduce unmet needs in people living with cancer compared with care as usual.

41 General Practices across England took part and were chosen by chance to be taught how to use the Needs Assessment Tool and offer an appointment to their patients, or to continue with usual care. Patients and carers were involved in and advised on the research processes from beginning to end.

A total of 788 people living with cancer and registered with CANAssess General practices took part in the study, and their carers if they had one.

We asked everyone to complete questionnaires about their unmet needs, symptoms and quality of life after agreeing to take part and one and three months later. We also asked most people to complete questionnaires after six months.

What we found

• At the start of the study, we found that just over half of participants had at least one moderate to severe unmet need.
• At one and three months follow-up, there was no noticeable benefit from the NAT-C compared to Usual Care in participants' reported level of unmet need, symptoms or quality of life.
• By six month follow-up, there was, however, consistent evidence of a benefit from the NAT-C in terms of unmet need, particularly psychological and physical needs, pain, appetite loss, and quality of life.
• Overall, participants in practices which delivered the NAT-C spent less time as a hospital in-patient, and overall costs to the NHS were lower.
• No differences were seen for caregiver outcomes.

We also asked the healthcare practitioners taking part whether they felt the Needs Assessment Tool could be used in everyday care.

• Practitioners told us the Needs Assessment Tool helped them deliver the standard of care they felt they should be providing, and it was valuable for providing proactive care for people with all stages of cancer.
• Challenges to everyday use included lack of time and money, and that the patients involved sometimes were not sure why such a wide range of topics were covered at the appointment or of its purpose.

Read more about this study in the patient results brief or clinicians' results brief.

Publications

Clark J, Copsey B, Wright-Hughes A, McNaught E, Bijsterveld P, McCormack T, Foy R, Wilkes S, Dickson JM, Meads D, Farrin A, Johnson M. Cancer patients' needs assessment in primary care: study protocol for a cluster randomised controlled trial (cRCT), economic evaluation and normalisation process theory evaluation of the needs assessment tool cancer (CANAssess). BMJ Open. 2022 May 4.