Holistic Needs Assessment

A Holistic Needs Assessment (HNA) gives you the chance to think about your concerns and discuss possible solutions. These concerns may be:

  • physical
  • emotional
  • practical
  • financial
  • spiritual.

You may be offered an HNA at diagnosis, during treatment or after treatment has ended. You can ask for an assessment at any time if you feel it would help.

An HNA usually has three parts:

  1. You answer a simple set of questions or fill in a checklist about all areas of your life.
  2. You discuss answers with your key worker.
  3. You create a care plan together.

The care plan may include ideas to help you manage your concerns. It will also include contact details for organisations or services that could help, such as the Macmillan benefits team or a dietitian.

You will be offered a copy of this plan to take away with you. It may also be shared with other members of your healthcare team if it will help with your care.

What is an HNA?

A Holistic Needs Assessment (HNA) gives you a chance to think about your concerns and discuss possible solutions.

It is called ‘holistic’ because the assessment looks at needs or concerns you may have about any area of your life and not just about the symptoms of the cancer.

These concerns can be:

  • physical
  • emotional
  • practical
  • financial
  • spiritual.

You will talk about these with your key worker and make a plan to address your care and support needs. A key worker is your main contact for information and advice about your treatment. This is usually your clinical nurse specialist (CNS).

Having an HNA is about recognising that any area of your life affected by cancer is important. It gives you the time to explore what resources, help and support are available.

What happens at an HNA?

An HNA usually has three parts:

  1. You answer a simple set of questions or fill in a checklist about all areas of your life. This is to identify any concerns you may have. You are often asked to rate how mild or severe your concerns are. This can help decide what needs to be dealt with first.
  2. You discuss answers with your key worker. This is a chance to talk about the issues you have identified. You can bring a carer, family member or friend to this meeting. 
  3. You create a care plan together. You will then discuss and plan how to deal with your concerns. This is sometimes referred to as a care plan.

The care plan may include things like ideas to help you manage emotional, physical or practical worries. It will also include contact details for organisations or services that could help with your concerns, such as the Macmillan benefits team or a dietitian.

Your key worker will write down the actions you agree on. You will then be offered a copy of this plan to take away with you. It may also be shared with other members of your healthcare team if it will help with your care.

HNA - Planning your care and support
HNA - Planning your care and support

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Benefits of having an HNA

  • You can get information and support for any symptoms or concerns you may have.
  • It can help you prioritise your most important concerns.
  • It can help your key worker understand what is important to you.
  • Your key worker can refer you to other services, if this would help.
  • You can find out about support groups in your area.
  • It can help you plan ahead – from diagnosis through to treatment and life after treatment.

When does the assessment happen?

You may be offered an HNA around the time of your diagnosis, during treatment or after treatment has ended. If this is not offered, you can ask your key worker for it. Because your needs may change, you can ask for an assessment at any time if you feel it would help.

You may have a separate appointment for the HNA, or it may happen at the same time as other appointments you are having.

You may be sent the checklist of questions in advance. Or you may be asked to fill one out in the waiting room before you meet with your key worker. Help will be available if you need it.

Who do I have the assessment with?

You will talk about your answers to the checklist of concerns with your key worker or another member of your healthcare team.

Whoever you speak to should have the skills and experience to help identify and discuss your concerns. They should have up-to-date knowledge of local and national services, and know how to refer you to additional services if you need them.

Tell your key worker if you would like a family member or friend with you for the discussion. If you have a carer, they may come with you and you can talk about their concerns too. A carer is someone who provides unpaid support to you, which you could not manage without. However, the assessment is mainly designed to focus on your needs and concerns. You can also ask for an interpreter if you need one.

How long will the assessment take?

For many people, the meeting takes about 30 minutes. You may feel there won’t be enough time to talk about some of your concerns or that they are not important enough to mention. But the HNA should take as long as you need to talk about your main concerns. If there are still issues you want to talk about at the end of the assessment, your key worker can make another appointment with you.

Where will the assessment take place?

The discussion should be held in a private and comfortable setting. If it is with your key worker, it will usually take place where you have your treatment or care, for example at the hospital or health centre. The assessment may also happen over the telephone. The options will be explained by your healthcare team. You should tell your key worker what you would prefer.

It’s a really good prompt. When you’re looking at the iPad you can just tick a box, and then they can go through it with you.

Tracy


Discussing your care

What the discussion may cover

These are your concerns, so it is up to you what you talk about in the discussion. You may want to discuss concerns such as:

  • physical symptoms (such as weight loss, problems with appetite or eating, and tiredness)
  • treatment issues (such as side effects, fertility, and the risks and benefits of treatment)
  • emotional concerns (such as worries about the future and relationships)
  • sexual concerns (such as erectile dysfunction or loss of sex drive)
  • family matters (such as talking about the cancer, and worries about genetic risk to other family members)
  • job, money or housing worries (such as balancing work and treatment, and benefits or financial advice)
  • practical issues (such as sorting out housework, and where to get equipment that can help)
  • spirituality (such as your faith or beliefs, and any impact this may have on your treatment).

The suggestions below may also help you decide what you would like to discuss.

We have information about the physical, emotional, practical and financial effects of cancer and about what may help.

Preparing for your discussion

To get ready for the discussion, some people find it helpful to make notes of any concerns or questions they have in advance.

You may want to think about these questions:

  • Is anything bothering you about your relationships with family or friends that could be related to the cancer?
  • Are your family and friends coping with knowing you have cancer?
  • Would you like to know about local services, support groups or helplines?
  • Do you need advice about diet, being physically active or stopping smoking?
  • Are you confused by any part of your treatment or follow-up care? Is there anything you would like to be explained?
  • Do you need help with finances, work or education?
  • Are you worried about the future?
  • Do you feel your quality of life could be improved?
  • Are you having any symptoms or side effects from the cancer or treatment?
  • Do you know what signs and symptoms to look for and who to contact if you notice any of them?
  • Do you know who to contact if you have any problems (for example, do you have the contact details of your key worker)?

These are suggestions. Not all of them may be relevant to you. The assessment is about your personal concerns, so you can tailor the discussion to your situation.

Your care plan

During the discussion, you will agree with your key worker the best ways to manage your concerns. These actions are put into a document called a care plan. Sometimes this is called a support plan.

Your care plan will record:

  • the main concerns you talked about during the discussion
  • suggestions and actions to help you manage your concerns
  • services that may be able to support you and any referrals that were made
  • what is already being done to help, or services you are using
  • information about who to contact if you need more help
  • which other health or social care professionals you have agreed to share the information with.

You should be given a copy of the care plan. Your key worker may write it during the discussion, or make notes and send it to you soon afterwards. You can request another copy from your key worker at any time.

A copy of the care plan may be sent or given to:

  • your GP, so they know your concerns and what help is planned
  • other members of your healthcare team, to help them plan or improve your care
  • specialist support services (such as a dietitian, counsellor, benefits adviser or family support worker).

Your key worker will only share your care plan with your permission. They will only share as much information as people need to know for their role in your care.

Your care plan will be securely stored electronically or as a paper copy along with your other health records.

You can ask your key worker for a review of your care plan or a new assessment at any time.

It made me think about what I was going through. It made me think, “oh, that’s normal”.

Samantha