Tuesday 16th December 2014
Mac Voice, the magazine for Macmillan professionals: Winter 2014
Leighton Mitchell looks at the evaluation of the eHNA programme so far. What does it tell us?
The initial eHNA pilot phase to test the concept in 2012 was evaluated by Ipsos Mori. The evaluation highlighted a number of key findings, including staff and user satisfaction with the ease of use of the eHNA, and time savings for staff. People living with cancer felt their holistic needs were being met, experienced better and more personalised support, and perceived assessment and care planning to be useful. Healthcare professionals placed greater recognition on the importance of assessments and care planning, and they had greater confidence to deliver them. Any reluctance among staff to administer eHNAs tended to stem from logistical difficulties of embedding the process in their daily routines, rather than a lack of appreciation of its value. The potential barriers to success were reported as IG, time and logistics (limited availability of clinic space and reliable WiFi).
Ipsos Mori have carried out further evaluation of the prototype sites using a mixed method approach to collecting data on the eHNA process, impact and cost effectiveness. It is both formative, informing the ongoing development of the eHNA, and summative, providing a thorough understanding of its impact. The evaluation included:
- Collection of data from Macmillan and the software developer.
- Online surveys with staff.
- In-depth exploration of eHNA implementation in a number of case study sites.
- A detailed examination of the benefits and costs of the eHNA from the perspective of people living with cancer.
- In-depth interviews with key stakeholders.
Progress so far
An Ipsos Mori survey compared the experiences of people who had completed an eHNA, people who had completed a paper HNA, and those who had neither assessment. A very brief overview of some of the main findings is provided below.
Most people living with cancer, particularly those who completed an eHNA, felt that they had received support at the right time:
'I'm not sure there's ever a good time, but for me at that particular point I knew I was going to be having surgery and it was a good time to think about what I was going through.'
The holistic needs of people living with cancer appear to be better met for those who have completed an electronic assessment, compared with those that recall completing a paper assessment or can't recall an assessment at all.
'I remember it being quite interesting because it covered a lot of things I didn't think we would talk about - emotional as well as physical needs really.'
'[There] was something on the questionnaire that I might not have thought was in [the nurse’s] sphere without the questionnaire.'
The data shows that there is an 80% conversion rate of electronic assessments into care plans.
Using the eHNA for research, service planning and commissioning
The eHNA not only helps clinicians to better tailor the care and support provided to address people's needs, but also gives a valuable source of information for research purposes and local service planning and commissioning. The aggregated data gives Macmillan an opportunity to investigate the needs of people living with cancer and how these are addressed.
Wide range of concerns expressed
Our early analysis showed that half of the concerns raised by people living with cancer using the eHNA relate to physical aspects of cancer survivorship (Figure 1). A further quarter related to emotional concerns, with anxiety being the most frequently reported. Family concerns, on the other hand, had the highest average rating. Such a wide spread of concerns further highlights the need for more holistic support for people living with cancer.
Before and during treatment, people are more likely to be concerned and ask about nutrition, and tend to ask more questions about physical activity and lifestyle (Figure 2). This suggests the potential for promotion of physical activity and lifestyle changes in cancer survivors at an earlier stage in the cancer care pathway - a potential 'teachable moment'. The emotional concerns reported suggest a higher need for emotional support during the cancer pathway.
The early data indicates that following eHNA and care planning, women are more likely to be referred to general support services (CNS and counselling) while men tend to receive more clinical help (medicine review, psychiatric referral). This was a small sample size and therefore is worth investigating further.
As the number of eHNA sites increases, we will continue evaluating the tool and drawing population-level conclusions on the relationship between age, gender, cancer type, cancer pathway and treatment intent, in relation to the needs of people living with cancer.
This is early data and a more detailed report will follow in the final evaluation, which is due in 2015.
Evaluation and Impact Officer
Evidence Department, Macmillan Cancer Support
1 Ipsos Mori. Evaluation of Holistic Needs Assessment: Final Report for NCSI Macmillan Cancer Support. October 2012. London.
2 Internal analysis of data for the 3-month period of 01/09/13–30/11/13 from 17 participating sites that have fully launched the eHNA