title: Feasibility and effectiveness of the NEST13+ as a screening tool for advanced illness care needs.
abstract: 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.
authors.affiliation: Buehler Center on Aging, Health and Society, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. kgscandrett@northwestern.edu
authors.forename: Karen G
authors.initials: KG
authors.lastname: Scandrett
authors.forename: Eva B
authors.initials: EB
authors.lastname: Reitschuler-Cross
authors.forename: Lauren
authors.initials: L
authors.lastname: Nelson
authors.forename: J Alex
authors.initials: JA
authors.lastname: Sanger
authors.forename: Maia
authors.initials: M
authors.lastname: Feigon
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Boyd
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chang
authors.forename: Judith A
authors.initials: JA
authors.lastname: Paice
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Hauser
authors.forename: Alexey
authors.initials: A
authors.lastname: Chamkin
authors.forename: Paul
authors.initials: P
authors.lastname: Balfour
authors.forename: Alexei
authors.initials: A
authors.lastname: Stolbunov
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Linda L
authors.initials: LL
authors.lastname: Emanuel
mesh_terms: 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*