Needs assessment in tertiary and secondary oncology practice: a conceptual and methodological exposition

Research Doctorate - Doctor of Philosophy (PhD)The purpose of this thesis was to explore the scientific viability of conducting needs assessments with oncology populations. In order to achieve this goal, a series of research studies was undertaken, the results of which are presented and discussed in Chapters 1 to 5. A summary of the implications of these research findings is presented in Chapter 6. Chapter 1 examines the concepts of 'needs' and 'needs assessment', and their potential relevance to the oncology field. The chapter provides a broad introduction to the theoretical and conceptual notions of needs and needs assessment' by incorporating perspectives from a diversity of disciplines such as history, biology, psychology, sociology, ecology, education and biomedicine. It leads into an exploration of the use of the terms 'needs' and 'needs assessment' in relation to oncology research, and specifically examines the ambiguous use of related terminology within the psycho-oncology field. It is argued that needs assessment is a distinctive method that may potentially benefit all participants within oncology delivery systems. A biopsychosocial model is presented in order to illustrate the potential role of needs assessment in reducing the morbidity outcomes of cancer, and to define its respective place within the oncology system. Having speculated about the potential valuable roles of needs assessment within oncology setting, the second chapter examines the existing literature in order to identify ways in which needs assessment methodology has been ultilised in relation to oncology patients. In particular, the chapter identifies the different methods by which the unmet needs of cancer patients have been assessed, and examines the scientific rigour of previous studies. Guidelines for the conduct of rigorous psychometric research are presented, followed by a critical review of the empirical literature. This process revealed a small body of research involving self-administered, self-reports of unmet needs by oncology patients, characterised by methodological flaws, conceptual limitations, and general lack of psychometric accountability. It is concluded that a major obstacle to the conduct of needs assessment in oncology settings is the absence of psychometrically sound assessment instruments. Chapter 3 presents a detailed discussion of the development of a new needs assessment instruments, the Cancer Needs Questionnaire (CNQ). The criteria for methodological acceptability (which are outlined in Chapter 2) were employed as the guiding standards against which the questionnaire was developed and evaluated. The questionnaire was initially pre- and pilot-tested, before being formally assessed in primary study involving a sample of ambulatory oncology patients (N=358) recruited from two major cancer centres. The results indicated that the CNQ provides a comprehensive measure of unmet needs in five broad domains (including psychological, health information, physical and daily living needs, patient support and support, and interpersonal communications), accounting for approximately 69% of the total variance. Substantive preliminary evidence was found for multiple indices of reliability and validity, including internal and external reliability, face and content validity, construct and discriminant validity. In order to facilitate the practical acceptability of the CNQ for administration in clinical settings, a short-form version of the instrument was extracted. The results of psychometric evaluations, which provide preliminary evidence for the reliability and validity of the short-form instrument, are also presented within this chapter. Having established the psychometric qualities of the CNQ assessment instrument, Chapter 4 presents the results of the prevalence assessment conducted in the primary study. The findings revealed a substantial prevalence of unmet need across all five domains, with the highest prevalence and magnitude of unmet needs observed in relation to the information and psychological domains, Logistic regression models provided further insights into the sociodemographic and clinical variables that were statistically related to higher unmet need scores in different life domains, The implications of these findings to the provision of optimal care for oncology patients are discussed, and tentative conclusions drawn regarding the potential role of needs assessment in tertiary oncology settings. Chapter 5 presents a rationale for employing needs assessment methodology in secondary oncology settings such as mammographic screening programs. The process undertaken to develop and psychometrically evaluate a needs assessment instrument for this population is described. The results of this psychometric evaluation suggested that the instrument measures four domains of need (including psychological, comfort, information, and post-screening needs), and has adequate internal reliability, face validity, content validity, construct validity, and discriminant validity. The sociodemographic and clinical variables identified as significant within logistic regression models for each domain of need are also presented. Differences between the perceptions of met and unmet needs by initial and recalled mammography attenders, and between the perceived needs of rural and urban mammography attenders, and between the perceived needs of rural and urban mammography attenders, provided further evidence for the criterion validity of the assessment scale. It is concluded that many mammographic clients experience unmet needs before, during and after the screening event, and that the magnitude of need varies as a function of the perceived probability of negative consequences. The final chapter speculates about the viability of utilising needs assessment methodology in oncology settings, The limitations and challenged of employing this methodology with oncology populations are outlined, together with possible solutions. it is concluded that needs assessment may be potentially useful methodology, however its successful implementation within oncology contexts as a routine component of quality assurance evaluations would require the commitment and cooperation of all participants in the oncology health delivery system, within the context of a supportive political macrosystem