1. Palliative care Challenging health need assessment
Lotte Rogg, MD, Ullevål Cancer center

2. Plan for this session Palliative care, definition
Health needs assessment
Corporate HNA
Comparative HNA
Epidemiological HNA
Challenges in needs assessment for palliative care

4. Palliative care
Palliative care is the active total care of patients whose disease is not responsive to curative treatment.
Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount.
The goal of palliative care is the achievement of the best
possible quality of life for patients and their families.
Palliative care affirms life and regards dying as a normal process, and neither hastens nor postpones death.
- European Association for Palliative Care (EAPC) / World Health Organization
(WHO)

5. Palliative care definition
No limitations regarding diagnosis
No limitations regarding health services
No clear limitations regarding when in disease trajectory

6. Development of palliative care in UK
Started late 60ies
Focus on cancer patients
Last days and weeks of life
Hospices
Palliative care units/ambulant teams
Moving towards non-cancer
Debate on when in disease trajectory

7. Models of care Curative Palliative Curative Palliative Palliative

8. Health needs assessment (HNA)
A systematic method of identifying unmet health and healthcare needs of a population, and making changes to meet those unmet needs
Used for service planning, monitoring/evaluation and responding to changing needs

9. the ability to benefit from health care
Need of health care
the ability to benefit from health care
Stevens and Raftery 1994

10. Corporate HNA
Based on demands, wishes and perpectives of interested parties
Important if policies are to be sensitive to local curcumstances
But might blur the difference between need and demand, science and vested interests
With the use of qualitative or quantitative methods, seeking to cover as many aspects and groups as possible (given economy and time frame)

11. Comparative HNA Contrasting services in one area with those elsewhere
Contrasting services available in one group with those in another

14. Epidemiological HNA Three sources of information: Size of the need
Services available locally
Effectiveness/cost-effectiveness of potential services

15. Six key steps Development of general categories: statement of problem
division into relevant subgroups
Determining the size of the need
Determining the current level of services
Determining effectiveness and cost-effectiveness
Bringing information together, making recommendations for future development of services

16. Development of general categories
Statement of the problem: defining palliative care, terminal illness, palliative medicine
Division into relevant subcategories: different palliative care services (hospice, generalist, specialist services), different diseases/groups of patients and families in need

18. Lung cancer vs COPD

21. Determining the size of the need
Incidence and prevalence. For each subcategory, estimate incidence and prevalence and calculate likely need.
in palliative care this often involves using data on death rates and symptoms experienced
local data best, if possible

22. But remember! Only as good as the quality of the data
Mortality rates says nothing about burden of disease, neither duration nor symptom burden or effect on carers
Patients often too weak to tell, use of proxies widespread in research/needs assessment

23. Determining current level of services
Nature and level of services currently provided
current availability and use of services, by subcategory
comparison of services available locally with those available elsewhere

25. Determining effectiveness/ cost-effectiveness
Reviewing effectiveness of services.
in palliative care outcome measures such as QoL, symptom control, impact on family and carers
often relying on existing systematic literature, if possible considered for different subgroups

28. Recommendations for future service development
Bringing together the information on need, available services and effectiveness, gaps and mismatches of provision
and thereby making recommendations for future development of services