Feasibility and effectiveness of the NEST13+ as a screening tool for advanced illness care needs.
BACKGROUND
A comprehensive whole-person approach might improve processes and outcomes of care for patients with cancer.


OBJECTIVE
To assess the ability of NEST13+ (Needs of a social nature; Existential concerns; Symptoms; and Therapeutic interaction), a screening and assessment tool, to identify social, emotional, physical, and care-system needs and to improve clinical outcomes for cancer patients in tertiary care.


METHODS
A controlled trial involving 451 patients hospitalized for cancer care at a comprehensive cancer center.


METHODS
Patients responded to 13 screening questions regarding possible care needs. When an individual response exceeded threshold levels, additional in-depth questions for the relevant need were asked. For patients in the intervention arm, clinical recommendations for each dimension of need were generated based on a previously developed NEST-response-driven menu, and were reported to the clinical team.


METHODS
Documented needs, clinician response, patient perception of goals alignment, and overall quality of palliative care.


RESULTS
Using the NEST13+ tool in the clinical setting facilitated greater documentation of illness-related needs than routine clinical assessment. Improvement in secondary outcomes was attenuated: changes in the clinician response were modest; changes in outcomes were not significant.


CONCLUSIONS
The NEST13+ tool facilitated identification of a wider range of important needs than traditional evaluation, while care outcomes were not improved. Traditional evaluation may need improvement. Future trials of the NEST13+ should focus on more intensive clinician-directed interventions.
Scandrett
Karen G
KG
Buehler Center on Aging, Health and Society, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. kgscandrett@northwestern.edu
Reitschuler-Cross
Eva B
EB
Nelson
Lauren
L
Sanger
J Alex
JA
Feigon
Maia
M
Boyd
Elizabeth
E
Chang
Chih-Hung
CH
Paice
Judith A
JA
Hauser
Joshua M
JM
Chamkin
Alexey
A
Balfour
Paul
P
Stolbunov
Alexei
A
Bennett
Charles L
CL
Emanuel
Linda L
LL
D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation*; D008875:Middle Aged; D020380:Needs Assessment; D009369:Neoplasms / Q000503:physiopathology / Q000628:therapy; D016522:Oncology Service, Hospital; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires / Q000592:standards*