Abstract
Purpose
Holistic needs assessment is a key recommendation in improving supportive and palliative care in adults with cancer. The Patients Concerns Inventory (PCI) is a holistic needs assessment tool designed for head and neck cancer survivors in outpatient setting. Routine screening of potential unmet needs in a clinic may result in increased onward referrals, thus placing a burden on existing healthcare services. The aim of this study was to compare the referral trends following consultation in the time periods before and after introduction of PCI in an oncology outpatient clinic.
Method
A cross-sectional cohort of disease-free survivors of oral/oropharyngeal cancers of a single consultant was prospectively exposed to PCI from July 2007 to April 2009. The PCI is a self-completed questionnaire consisting of 55 items of patient needs/concern and a list of multidisciplinary professionals, whom patients may wish to talk to or be referred to. Retrospective analysis of referral patterns from clinic letters in two periods in the pre-PCI and post-PCI exposure was performed. Prospective analysis of consultations was performed to determine the outcome of PCI-highlighted items.
Results
There was no change in the prevalence of onward referral with the introduction of PCI, i.e. 21 referrals per 100 patients seen in outpatients. However, the proportion of referrals to oral rehabilitation and psychological support increased. Referrals to certain services, e.g. speech and language and dentistry, remained consistently in demand. Many PCI-highlighted needs were dealt in a clinic with by the consultant and/or other professionals during a multidisciplinary consultation.
Conclusions
Routine use of PCI promotes target efficiency by directing and apportioning appropriate services to meet the needs for supportive care of head and neck cancer survivors.
References
Chen SC, Lai YH, Liao CT, Chang JT, Lin CC (2009) Unmet information needs and preferences in newly diagnosed and surgically treated oral cavity cancer patients. Oral Oncol 45(11):946–952
Gibson MK, Forastiere AA (2004) Multidisciplinary approaches in the management of advanced head and neck tumors: state of the art. Curr Opin Oncol 16(3):220–224
Rogers SN, Clifford N, Lowe D (2011) Patient and carer unmet needs: a survey of the British association of head and neck oncology nurses. Br J Oral Maxillofac Surg. doi:10.1016/j.bjoms.2010.06.017
Rogers SN, McNally D, Mahmoud M, Chan MF, Humphris GM (1999) Psychologic response of the edentulous patient after primary surgery for oral cancer: a cross-sectional study. J Prosthet Dent 82:317–321
SollnerW DeVries A, Steixner E et al (2001) How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counselling? Br J Cancer 84:179–185
Rogers SN, El-Sheikha J, Lowe D (2009) The development of a Patients Concerns Inventory (PCI) to help reveal patients concerns in the head and neck clinic. Oral Oncol 45:555–561
Millsopp L, Frackleton S, Lowe D, Rogers SN (2006) A feasibility study of computer-assisted health-related quality of life data collection in patients with oral and oropharyngeal cancer. Int J Oral Maxillofac Surg 35(8):761–764
Woolley E, Magennis P, Shokar P, Lowe D, Edwards D, Rogers SN (2006) The relationship between deprivation indices and health related quality of life in oral and oropharyngeal squamous cell carcinoma. Brit J Oral Maxillofacial Surg 44:177–186
Rogers SN, Scott B, Lowe D, Ozakinci G, Humphris GM (2011) Fear of recurrence following head and neck cancer in the outpatient clinic. Eur Arch Otorhinolaryngol 267(12):1943–1949
Stevens A, Gillam S (1998) Needs assessment: from theory to practice. BMJ 316:1448
Lynch J, Goodhart F, Saunders Y, O'Connor SJ (2010) Screening for psychological distress in patients with lung cancer: results of a clinical audit evaluating the use of the patient distress thermometer. Support Care Cancer 19(2):193–202
Fulcher CD, Gosselin-Acomb TK (2007) Distress assessment: practice change through guideline implementation. Clin J Oncol Nurs 11(6):817–821
Tuinman MA, Gazendam-Donofrio SM, Hoekstra-Weebers JE (2008) Screening and referral for psychosocial distress in oncologic practice use of the distress thermometer. Cancer 113:870–878
Hughes KL, Sargeant H, Hawkes AL (2011) Acceptability of the distress thermometer and problem list to community-based telephone cancer helpline operators, and to cancer patients and carers. BMC Cancer 11:46
Katre C, Johnson IA, Humphris GM, Lowe D, Rogers SN (2008) Assessment of problems with appearance, following surgery for oral and oro-pharyngeal cancer using the University of Washington appearance domain and the Derriford appearance scale. Oral Oncol 44(10):927–934
Flexen A, Ghazali N, Lowe D, Rogers SN (2011) Identifying appearance-related concerns in routine follow-up clinics following treatment for oral and oropharyngeal cancer. Br J Oral Maxillofac Surg (in press)
National Institute of Clinical Excellence (2004) Guidelines on improving supportive and palliative care for adults with cancer. The manual. London. http://www.nice.org.uk/csgsp. Accessed 13 March 2011-03-16
Rogers SN, Brown JS, Woolgar JA et al (2009) Survival following primary surgery for oral cancer. Oral Oncol 45(3):201–211
Richardson A, Medina J, Brown V, Sitzia J (2007) Patients’ needs assessment in cancer care: a review of assessment tools. Support Care Cancer 15:1125–1144
Conflict of interest
The authors have no conflict of interest to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ghazali, N., Kanatas, A., Langley, D.J.R. et al. Treatment referral before and after the introduction of the Liverpool Patients Concerns Inventory (PCI) into routine head and neck oncology outpatient clinics. Support Care Cancer 19, 1879–1886 (2011). https://doi.org/10.1007/s00520-011-1222-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-011-1222-9