Having a Holistic Needs Assessment

What is an HNA?

A Holistic Needs Assessment (HNA) is an assessment and discussion you may have with someone from your healthcare team. Together, you talk through your needs and concerns. You then agree on a plan for your care and support needs.

It is called holistic because you can discuss any needs or concerns you have about any area of your life. It is not only about the physical symptoms of cancer or the side effects of treatment.

These concerns can be:

physical
emotional
practical
financial
spiritual.

HNAs may not be standard practice in all hospitals. The HNA may happen in the ways we describe here, or it may be more informal. If you are not offered an HNA and would like one, you can ask someone from your healthcare team about it.

Booklets and resources

What happens at an HNA?

An HNA usually has three parts:

You answer a simple set of questions or fill in a checklist about all areas of your life. This is to find out about the concerns you may have. You are often asked to rate how important these concerns are to you. This can help you decide what to discuss first during the assessment.
You discuss your answers with someone from your healthcare team. This is a chance to talk about the issues that are most important to you.
You create a care plan together for managing your concerns. This is sometimes called a personalised care and support plan. If there are simple ways to help you, you may not need a written care plan.

What are the benefits of having an HNA?

You can get information and support to help you manage your concerns.

It can help you identify the concerns that are most important to you.
It can help your healthcare team understand what is important to you.
You can be referred to other services if you need more help or support.
You can find out about local support groups.
It can help you plan ahead.

Who do I have the HNA with?

You have the HNA with someone from your healthcare team, usually your key worker. Sometimes you have it with a cancer support worker who works alongside them. Your key worker is usually your clinical nurse specialist (CNS) or another member of your healthcare team. They are your main contact for information and advice. If you have not been given a key worker, ask your cancer doctor or GP about who can do the HNA with you.

Your key worker has the skills and experience to help you identify your needs and talk about them with you. They also have up-to-date knowledge of local and national services. They can refer you to other support services you may need. They may print out some Macmillan information to give to you.

If you are having a face-to-face assessment, you can bring a family member, carer or friend with you. You can ask for an interpreter if you need one.

When does the HNA happen?

You may be offered an HNA around the time when you are diagnosed, during treatment or after treatment has ended. If you are not offered an HNA, you can ask someone from your healthcare team to arrange one for you. Because your needs may change, you can ask for another HNA at any time.

You may have a separate appointment for the HNA. Or it may happen at the same time as one of your other appointments.

You may be sent the checklist of questions to do before the HNA. Or you may be asked to do it in the waiting room beforehand. The checklist may be a paper copy or on a handheld electronic device (tablet). If it is done on a tablet, it is called an eHNA. If you need help answering the questions, tell your key worker.

Where will the HNA happen?

The HNA should be done in a private and comfortable room. If you have it with your key worker, this is usually at the hospital or health centre. Sometimes it may happen over the phone.

How long will the HNA take?

The HNA usually takes about 30 minutes. Some people may need longer. It should take as long as you need to talk about your concerns. If there are still some things you want to talk about after it has finished, tell your key worker. They can make another appointment with you.

What the discussion may include?

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

Your physical symptoms – such as pain, tiredness, bowel or bladder problems, and weight changes.
Your treatment – such as side effects, fertility and the risks and benefits of treatment.
Your emotions – for example, fear of cancer coming back or the effect of cancer on your relationships.
Your sexual well-being – such as concerns about intimacy, getting an erection or low sex drive.
Your family – such as how to talk about cancer, or worries about genetic risk.
Your well-being after treatment – for example, giving up smoking, eating healthily or staying active.
Follow-up appointments, tests you may need and knowing what symptoms to look out for.
Work, money and housing – for example, advice about working during treatment, benefits and financial help
Practical issues – such as how to manage housework and where to get aids and equipment to help you.
Spirituality – such as your faith or beliefs and whether your cancer experience has affected these.

For some practical or financial issues, your healthcare worker may refer you to other health or social care services. These will give you further advice and support.

Remember, the concerns we have listed above are only a guide. Not everything listed will apply to you. Or you may have concerns that are not listed. We have some suggestions below to help you decide what you would like to discuss.

Your care plan

During the discussion, you and your key worker will agree on the best ways to manage your needs and concerns. They may write down what you have agreed in a document called a care plan. This is sometimes called a personalised care and support plan. They may write it during the discussion. Or they may make notes and send it to you afterwards.

Your care plan will record:
the main concerns you talked about
suggestions and actions to help you manage your concerns
services that may be able to support you, and any referrals that are made
what is already being done to help – for example, the services you are already using
information about who to contact if you need more help
the details of other health or social care professionals you have agreed to share the information with.

Your key worker usually gives you a copy of your care plan. If your discussion is with a cancer support worker, your final care plan will always be agreed with your key worker. If you are not offered a copy of your care plan, you can ask your key worker for one 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 – for example, a dietitian or counsellor.

Your key worker will only share your care plan with your permission. They will only share as much information as people need to help with your care.

Your care plan will be securely stored 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.

Getting support

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line for free on 0808 808 00 00.
Chat to our specialists online
Visit our Online Community to talk to people who have been affected by cancer, share your experience, and ask an expert your questions.

About our information

References

Below is a sample of the sources used in our Holistic Needs Assessment (HNA) information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

European Society for Medical Oncology: Supporting self management of patients and family members. 2019.

Johnstone et al. The implementation and impact of Holistic Needs Assessments for people affected by cancer: a systematic review and thematic synthesis of the literature. European Journal of Cancer Care. 2019. Vol 28.

Macmillan Cancer Support. Providing personalised care for people living with cancer: a guide for professionals providing holistic needs assessments, care and support planning. 2019.

Maher, J et al. Implementation of nationwide cancer survivorship plans: Experience from the UK. Journal of Cancer Policy. 2018. Vol 15, pp 76-81.

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.