Assess Palliative Care Needs
Palliative care can be defined as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." (World Health Organisation, 2016)
Patient assessment is a critical step in identifying when patients would benefit from palliative care. A palliative approach and palliative care needs assessment should be considered for any patient when you would not be surprised if they died within the next twelve months.
The life experiences of a person such as age, culture, religion, ethnicity or experience should be considered.
Re-assessment of palliative care needs should occur regularly and at key transition points in the patient’s trajectory, for example:
- if there has been a significant functional or medical decline,
- if there is a sudden acute event,
- if discussions around goals of care are required particularly around futile treatment,
- following hospitalisation.
The Palliative Care Needs Assessment Guidance
The Palliative Care Needs Assessment Guidance was developed by the National Clinical Programme for Palliative Care and is a framework that considers needs across four domains:
- Domain 1 - Physical Wellbeing
- Domain 2 - Social and Occupational Wellbeing
- Domain 3 - Psychosocial Wellbeing
- Domain 4 - Spiritual Wellbeing
If your service uses electronic notes you may already have these domains within your clinical system. Similarly, your hard copy notes may address these issues. Review your system and see if all the domains are covered. Within each of these domains there are some specific tools or scales that might be useful to understand the needs of the client and their family. The Assessment Tools section provides information on these domains.
- Assessment Tools
- Family Resources
Each client will have an individual symptom profile and a comprehensive assessment is required.
The Symptom Assessment Scale (SAS) can be used as a self-report tool and provides a report of whether a symptom is present and indication of impact of that symptom. The SAS is based on a rating scale of seven common symptoms and has space to add additional symptoms. The Palliative Care Outcomes Collaboration (PCOC) has a brochure explaining the Symptom Assessment Scale (168kb docx).
Where a symptom has been identified further assessment using valid and reliable tools, if available, should be used to identify the underlying cause of the symptom and further details. The following is a suggested list of tools for common symptoms. You may have some of these in your electronic or hard copy files.
Also The Palliative Care Bridge has a video on assessing pain for people unable to communicate.
- Dyspnoea (shortness of breath) Assessment
- The Modified Borg Scale (mBORG) (181kb pdf)
Lung Foundation Australia
The Modified Borg Dyspnoea Scale (mBORG) is used to measure the self-reported intensity of the sensation of breathlessness for individuals who may have difficulty with a numeral rating, but can identify their dyspnoea level using verbal descriptors. The mBORG rates dyspnoea on a scale of 0-10 to quantify the intensity of dyspnoea during activity.
- Delirium Assessment
- Nutrition Assessment
- Oral Health Assessment
This domain is based around family support, emotional and social support and practical concerns.
A comprehensive social assessment helps to identify family, emotional and social support. The use of a genogram is helpful, particularly if the client's family is large or there are a variety of different individuals who will provide support.
The client's life biography assists in providing person-centred care, particularly for clients with cognitive impairment or dementia. There are a range of tools that can be used to identify the person’s biography. The Personal Life History Booklet (338kb pdf) is one resource. You may already have this or something similar as part of your admission and assessment process.
Clients at the end of life should be assessed for any issues that are worrying them. In particular, awareness of the possibility of psychological concerns such as anxiety, depression or previous mental health issues.
- CareSearch provides an overview for anxiety and depression in palliative care. There is information on conducting a psychosocial assessment, which helps in better understanding a person’s holistic needs in their social and cultural context to guide the development of a person-centred care plan.
- Kessler Psychological Distress Scale (K10) (64kb pdf)
Black Dog Institute
The K10 is a simple measure of psychological distress as a measure of outcomes following treatment for common mental health disorders. The K10 asks 10 self-reported questions with a 5-value scale. The maximum score is 50 indicating severe distress and the minimum score is 10 indicating no distress.
The final domain is about assessing the spiritual needs of clients. palliAGED provides a summary of spiritual care.
A person’s spiritual care includes faiths, cultures, beliefs, and traditions and is the right of older people to express their spirituality in a way that is meaningful for them. The identification of spiritual needs and offering of basic spiritual care is the responsibility of all aged care workers and should be done in ways that are appropriate to their role.
Meaningful Ageing Australia developed the National Guidelines for Spiritual Care in Aged Care, (831kb pdf) which gives an overview of some key spiritual needs of older people, including the five domains of spiritual care.
It is also important for carers to identify their own needs and the level of concern they cause. CareSearch has information addressing carers’ needs including information on how to look after yourself, which includes tips and links to websites and factsheets.
Needs Assessment Tool for Carers (NAT-CC - Caring for you) (149kb pdf)
University of Queensland
The NAT-CC is a self-reported tool for carers supporting someone with a chronic illness. The tool identifies the care needs of someone living with a chronic condition, and the level of concern this causes the carer. This provides prompts for the carer and/or the health professional to discuss these issues.