title: Development and initial validation of the Three-Levels-of-Needs Questionnaire for self-assessment of palliative needs in patients with cancer.
abstract: BACKGROUND
  To improve palliative care, it is important that questionnaires accurately assess the needs of the patients. No questionnaire existed that combined three different and important approaches to needs assessment. We developed such a questionnaire, called the Three-Levels-of-Needs Questionnaire (3LNQ), based on literature searches. The 3LNQ measures 12 important needs with three different approaches when used as a supplement to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): problem intensity, problem burden, and felt need.
  
  
  OBJECTIVE
  To investigate the initial validity of the 3LNQ.
  
  
  METHODS
  We used a relatively new method that investigates whether the questionnaire has the same meaning for the patients as for the researchers. To do this, 74 patients with advanced cancer filled out the questionnaire and participated in an open-ended interview. The patients' responses to the questionnaire before the interview were compared against the researchers' responses based on the interviews. Items showing substantial agreement were accepted as valid without further analysis. For the remaining items, reasons for disagreements were analyzed qualitatively.
  
  
  RESULTS
  All items on problem intensity, eight of 12 items on problem burden, and three of 12 items on felt need were accepted as valid because of high agreement. Analysis of the qualitative data concerning the remaining items showed that most disagreements did not indicate problems with the patients' self-assessment. Instead, different causes for disagreements were elucidated, but these did not interfere with validity.
  
  
  CONCLUSIONS
  The 3LNQ appears to measure palliative needs comprehensively, and this initial validation showed satisfactory results. The analysis gave important insights into the patients' perceptions of their own situations, into their expectations of the health care system, and into the complexity of needs assessment.
authors.affiliation: The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital 20D, Copenhagen, Denmark. ajoh0005@bbh.regionh.dk
authors.forename: Anna Thit
authors.initials: AT
authors.lastname: Johnsen
authors.forename: Morten A
authors.initials: MA
authors.lastname: Petersen
authors.forename: Lise
authors.initials: L
authors.lastname: Pedersen
authors.forename: Mogens
authors.initials: M
authors.lastname: Groenvold
mesh_terms: D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D059026:Diagnostic Self Evaluation; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000451:nursing*; D010146:Pain / Q000453:epidemiology* / Q000451:nursing*; D010166:Palliative Care / Q000706:statistics & numerical data*; D010865:Pilot Projects; D015995:Prevalence; D011795:Surveys and Questionnaires