title: A Pilot Randomized Controlled Trial of a Holistic Needs Assessment Questionnaire in a Supportive and Palliative Care Service.
abstract: BACKGROUND
  At present, there is no widely used systematic evidence-based holistic approach to assessment of patients' supportive and palliative care needs.
  
  
  OBJECTIVE
  To determine whether the use of a holistic needs assessment questionnaire, Sheffield Profile for Assessment and Referral for Care (SPARC), will lead to improved health care outcomes for patients referred to a palliative care service.
  
  
  METHODS
  This was an open, pragmatic, randomized controlled trial. Patients (n = 182) referred to the palliative care service were randomized to receive SPARC at baseline (n = 87) or after a period of two weeks (waiting-list control n = 95). Primary outcome measure is the difference in score between Measure Yourself Concerns and Wellbeing (MYCAW) patient-nominated Concern 1 on the patient self-scoring visual analogue scale at baseline and the two-week follow-up. Secondary outcomes include difference in scores in the MYCAW, EuroQoL (EQ-5D), and Patient Enablement Instrument (PEI) scores at Weeks 2, 4, and 6.
  
  
  RESULTS
  There was a significant association between change in MYCAW score and whether the patients were in the intervention or control group (χ(2)trend = 5.51; degrees of freedom = 1; P = 0.019). A higher proportion of patients in the control group had an improvement in MYCAW score from baseline to Week 2: control (34 of 70 [48.6%]) vs. intervention (19 of 66 [28.8%]). There were no significant differences (no detectable effect) between the control and intervention groups in the scores for EQ-5D and Patient Enablement Instrument at 2-, 4-, or 6-week follow-up.
  
  
  CONCLUSIONS
  This trial result identifies a potential negative effect of SPARC in specialist palliative care services, raising questions that standardized holistic needs assessment questionnaires may be counterproductive if not integrated with a clinical assessment that informs the care plan.
authors.affiliation: Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences. Electronic address: n.ahmed@sheffield.ac.uk.
authors.forename: Nisar
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: School of Nursing and Midwifery.
authors.forename: Philippa
authors.initials: P
authors.lastname: Hughes
authors.affiliation: School of Nursing and Midwifery.
authors.forename: Michelle
authors.initials: M
authors.lastname: Winslow
authors.affiliation: Health Informatics Research Group, Information School, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Bath
authors.affiliation: Centre for Health and Social Care Research, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom.
authors.forename: Karen
authors.initials: K
authors.lastname: Collins
authors.affiliation: Academic Unit of Supportive Care, School of Medicine and Biomedical Sciences.
authors.forename: Bill
authors.initials: B
authors.lastname: Noble
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006694:Holistic Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D012017:Referral and Consultation; D016896:Treatment Outcome
keywords: EQ-5D; MYCAW; PEI; Palliative care; SPARC; holistic needs assessment questionnaire