A pilot randomized controlled trial of a holistic needs assessment questionnaire in a supportive and palliative care service

Context

At present, there is no widely used systematic, evidence-based holistic approach to assessment of patients’ supportive and palliative care needs.

Objectives

To determine whether the use of a holistic needs assessment questionnaire, SPARC, will lead to improved health care outcomes for patients referred to a palliative care service.

Methods

This was an open, pragmatic, randomized controlled trial. Patients (N=182) referred to the palliative care service were randomized to receive SPARC at baseline (n=87) or after a period of two weeks (waiting list control n=95). Primary outcome measure: difference in score between MYCAW patient-nominated concern 1 on the patient self-scoring visual analogue scale at baseline and the two-week follow-up. Secondary outcomes: difference in scores in the MYCAW, EQ-5D, and PEI scores at weeks 2, 4 and 6.

Results

There was a significant association between change in MYCAW score and whether the patients were in the intervention or control group (χ2trend = 5.51; df = 1; P = 0.019). A higher proportion of patients in the control group had an improvement in MYCAW score from baseline to week 2: Control: 34 of 70 (48.6%) vs. Intervention: 19 of 66 (28.8%). There were no significant differences (no detectable effect) between the control and intervention groups in the scores for EQ5D and PEI at 2-, 4-, or 6-week follow-up.

Conclusion

This trial result identifies a potential negative effect of SPARC in specialist palliative care services, raising questions that standardized holistic needs assessment questionnaires may be counterproductive if not integrated with a clinical assessment that informs the care plan.