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PubMed2001

The use of the Index of Orthodontic Treatment need (IOTN) in a school population and referred population.

The aim of this study is to assess the need for orthodontic treatment in a Turkish school population and a group of population referred for orthodontic treatment. The study groups were 250 school children, 11-14 years of age, and 250 patients, 11-14 years of age, referred to the department of orthodontics. The Index of Orthodontic Treatment Need (IOTN) was used by two examiner in order to estimate the treatment need. The differences between the IOTN values for the boys and girls were also not statistically significant in both groups. When the dental health component of IOTN is considered, 38.8 per cent of Turkish school population showed great need treatment, 24.0 per cent moderate need treatment and slight or no need was 37.2 per cent. On the other hand, the referred population represented an 83.2 per cent great need treatment, 12.0 per cent moderate need treatment, 4.8 per cent no need treatment according to the DHC. The AC of IOTN in school population resulted in 4.8 per cent great need, 4.8 per cent moderate need, 90.4 per cent no need. These percentage were 36.8 per cent great need, 17.6 per cent moderate need, 45.2 per cent no need in referred population. Grade 8 was 28.8 per cent out of the 36.8 per cent great need percentage in referred population. Therefore, it can be concluded that the ectopic canines were the driving factor for the referred population.

Adolescent↗

PubMedDate not supplied

Problems experienced by the informal caregivers of cancer patients and their needs for support.

Informal caregivers experience problems of their own for which they need support, but despite the efforts of the World Health Organization to include the well-being of family members and caregivers in the concept of palliative care, their needs are rarely assessed systematically. This report explores caregivers' problems and their needs for professional support. Seventy-six caregivers of cancer patients with advanced disease completed a comprehensive needs assessment questionnaire, the Problems and Needs in Palliative Care questionnaire-caregiver form, listing 67 potential problems in their quality of life and their role of caregiver and 9 items concerning informational needs. The results of this study reveal that the "Top 20" list of the problems and needs reported by caregivers includes fears and emotional burdens; for the most part, caregivers did not need any more professional attention than they were already receiving. Many, however, needed support for managing patients' symptoms and wanted professional attention for the availability and coordination of services. Despite communalities, there was diversity in caregivers' individual needs. Personal needs could be identified with the Problems and Needs in Palliative Care questionnaire-caregiver form checklist. Although only a few caregivers were affected by some issues, such as financial problems, help for them was often needed. In conclusion, most caregivers would like more professional attention for 4 or 5 specific issues, often related to their competence as caregivers for their patients. Using structured needs assessments with the Problems and Needs in Palliative Care questionnaire-caregiver form seems a feasible method to identify the needs of individual caregivers in palliative care.

Adult↗

PubMed2006

Longitudinal patterns of alcohol, drug, and mental health need and care in a national sample of U.S. adults.

OBJECTIVE: Use of longitudinal data can help clarify the extent of persistent need for services or persistent problems in gaining access to services. This study examined the level of transient and persistent need and unmet need over time among respondents to a national survey and whether need was met by provision of mental health services or resolved without treatment. METHODS: Data from the longitudinal Health Care for Communities (HCC) household telephone survey were used to produce joint distributions of need status and care for two periods (wave 1 data collected in 1997 to 1998 and wave 2 data collected in 2000 to 2001; N=6,659). Perceived need was measured as self-report of need for help with a mental or substance use problem. Probable clinical need was assessed with the Composite International Diagnostic Interview, the Alcohol Use Disorders Identification Test, and the 12-item Short Form Health Survey. RESULTS: High levels of persistent unmet need for care (44 to 52 percent) were found among respondents who had probable clinical need in wave 1. Although a majority of those with need received some care, an equal proportion (about 30 percent) of those with perceived need only or probable clinical need in wave 1 did not receive any care. A substantial portion of need (22 to 26 percent) appears to have resolved without treatment, which may suggest high levels of transient need. CONCLUSIONS: Persistent patterns of unmet need represent important targets for policy and programs that can improve utilization, including outreach, education, and improved insurance coverage.

Adolescent↗

PubMed1999

Psychological and symptom distress in terminal cancer patients with met and unmet needs.

This study identified the needs of terminal cancer patients, investigated the factors associated with unmet needs, and assessed psychological and symptom distress associated with unsolved needs. Ninety-four patients were randomly selected from 324 patients admitted for palliative care in 13 Italian centers. Two self-administered questionnaires (the Symptom Distress Scale and the Psychological Distress Inventory) were administered to all the patients. Patients needs were identified using a semi-structured interview, aimed at exploring five areas: physiological needs, safety needs, love and belonging needs, self-esteem needs, self-fulfillment needs. A content analysis of the answers defined 11 needs, and identified patients with unmet needs. The most frequent unmet needs were symptom control (62.8%), occupational functioning (62.1%), and emotional support (51.7%). The less frequently reported needs were those related to personal care (14.6%), financial support (14.1%), and emotional closeness (13.8%). Low functional state was significantly associated with a high proportion of patients with unmet needs of personal care, information, communication, occupational functioning, and emotional closeness. Patients with unmet needs showed significantly higher psychological and symptom distress for most needs. This study provides some suggestions about the concerns that should be carefully considered during the late stage of cancer.

Aged↗

PubMed2003

[A study of children with special needs in mainstream schools and the role of nursing teachers].

OBJECTIVE: Principals of elementary schools and classroom teachers of classes for children with special needs were surveyed by questionnaire to identify the features of children with special needs in mainstream schools and the role of nursing teachers. METHODS: Subjects in Y prefecture were asked to consider several items including the following: 1) presence in class of children with special needs; 2) presence of a child with special needs who was a target of a class or a school for children with special needs; 3) presence of education for special needs experience; 4) obstacles that such children face; 5) the relation with a nursing teacher from June to August in 1998. RESULTS: 1. There was no class for children with special needs in 87 among 135 schools. Children with special needs were present in 27 out of 87 schools, and the frequency of children with special needs was about 0.3% in mainsteam classes. 2. The total number of children in classes for special needs was 177 including 142 (79.8%) with intellectual disabilities, 77 (43.3%) with complex disabilities and 61 (34.3%) requiring medical care. 3. Ninety percent of teachers of special needs classes asked a school nurse about health care for special needs and how to cope with matters relating to disabilities. 4. Ninety percent of teachers of special needs classes were concerned about matters such as the method of teaching and coping with matters relating to disabilities. CONCLUSION: The survey found that there are children with special needs in mainstream classes. The situation with the disabilities is an appreciable number of complex, so teachers of special needs classes had many concerns. Those teachers are inclined to be isolated in school. To achieve good educational outcomes for children with special needs it is important to develop a systematic network between school and experts such as medical doctors and educational professionals. Nursing teachers could play an important role in their relation, with medical specialists.

Child↗

PubMed1990

Monitoring quality-of-life needs of cancer patients.

The advent of prepayment systems in hospitals has greatly shortened the length of stay of patients who are therefore increasingly treated and cared for in outpatient settings while living at home with family or other caretakers. This shift in the locus of treatment has created a critical need for the development of organized systems of follow-up that monitor a patient's needs while he or she is undergoing active treatment but living at home. Over time, failure to develop such systems of care is likely to result in major gaps in the continuity of care, a decrease in the quality of patients' lives while on treatment, tremendous stress on caretakers, and a general decrease in the quality of services provided to patients. This article reports on a study of one such system of monitoring i.e., a computer-automated telephone outreach system that would routinely assess the concrete needs of chemotherapy outpatients (e.g., transportation to the hospital and need for assistance with activities of daily living). This automated intervention was designed in response to previous findings that 62% of chemotherapy outpatients had at least one unmet need within the month before assessment and 39% had two or more; clinical knowledge that cancer patients' needs vary considerably over time as a consequence of both the disease and its treatment; and that, because of limited professional staff, patients' needs cannot be routinely assessed without the aid of automation, particularly as the proportion of cancer patients treated as outpatients continues to increase. These conditions suggested the need to develop a cost-efficient strategy for the universal assessment of patients' need on a periodic basis, so that emerging needs could be identified in a timely way. For the feasibility study, 97 chemotherapy outpatients were surveyed at least once over the telephone by a computer in a high quality digitally-stored voice asking 12 questions regarding the patients' concrete needs. The data suggested that our computer-automated telephone outreach system is reliable and valid and has the potential for relatively broad-based acceptance. In addition, the intervention frequently allows for timely social work assistance for identified needs. It further serves as a form of outreach that can compensate for patients' reluctance to identify themselves as needing help and for passivity that may be associated with depression or physical illness. This intervention appears to have the potential to be a time- and labor-efficient strategy for ongoing assessment of the changing needs of large numbers of cancer or other chronic diseased outpatients, insuring timely professional intervention as needs arise.

Activities of Daily Living↗

PubMed2002

Objectivity in needs assessment practice: admission to a residential home.

In 1997, the Dutch government installed independent agencies to assess the long-term care needs of individual clients and to give advice on the allocation of appropriate services. Needs assessors assess, among other things, the eligibility of clients requesting admission to a residential home. According to guidelines, needs assessors should do this objectively and independently from care providers and health care insurers. The present paper examines how needs assessors explore the clients' expressed needs, determine their normative needs and advise on allocation. Needs assessors perform these tasks in a situation where a clear professional framework is absent, and moreover, residential home capacity is limited. A qualitative study was undertaken, observing 13 house calls of clients requesting admission to a residential home. Furthermore, interviews were held with all needs assessors and a document analysis was made. It was found that needs assessors use comparable methods in exploring the clients' motivation and assessing their needs in the relevant areas, apparently using a professional framework. However, when transforming the needs of clients into an adequate allocation, needs assessors struggled with interpretation of criteria and included their personal ideas of services into the allocation decision. The paper concludes with the suggestion that further professionalisation may lead to a greater uniformity in needs assessment practice, and will assist needs assessors in the difficult task of transforming clients' needs into long-term care allocation advice.

Aged↗

PubMed2003

The relationship of needs and quality of life in persons with schizophrenia living in the community. A Nordic multi-center study.

The relationship between needs for care and support and subjective quality of life was investigated in a cross-sectional multi-center study including 418 individuals with schizophrenia from 10 centers in Nordic countries. Needs in 22 domains were investigated by interviews with key workers and their patients using the Camberwell Assessment of Need scale, and quality of life by the Lancashire Quality of Life Profile. The results showed that key workers rated slightly more needs than patients. To have more unmet needs, as rated by both key workers and patients, were correlated to a worse overall subjective quality of life, while met needs showed no such association. A regression analysis, controlling for clinical and social characteristics of the patients, showed more unmet needs to be associated with a worse quality of life, accounting for 6% out of a total of 41% explained variance in subjective quality of life. Regression analyses of the relationship of unmet needs in specific life domains and overall quality of life showed that unmet needs in five domains as perceived by patients accounted for 17% of the explained variance in overall quality of life. More than half of this variance was related to an unmet need in the domain of social relationships. It is concluded that unmet needs are of specific importance in needs assessment and that attention must be paid to separate met needs for care and services from unmet needs, since the latter seem more important to consider in order to improve outcome of interventions with regard to quality of life. Specific attention should in this context also be paid to unmet needs concerning social relationships and problems with accommodation.

Adult↗

PubMed1997

A descriptive study of the self-perceived needs of carers for dependants with a range of long-term problems.

BACKGROUND: This study aimed to identify qualitatively the need for health and social care of carers looking after dependants from different patient groups in a geographically defined area--Fife, Scotland. It was the first stage of a systematic process designed to assess and meet carers' needs. METHOD: Subjects for the study were unpaid (or 'informal') carers looking after dependants who were known to statutory or voluntary services. A series of 14 focus group discussions with carers of dependants from seven different patient groups took place. The main outcome measure was the qualitative descriptions of carers' self-reported health and social needs. RESULTS: Needs 'common' to carers across all care groups were identified. These related to the need for: information (diagnostic, prognostic and where to obtain help), improved communication with professionals, relief from stress, respite care, training and practical support. Within each area of 'common' need, carers had specific needs, which related to the particular needs of their dependant. There were also needs that were identified by carers from one or more patient groups. Carers did not necessarily recognize themselves as carers at an early stage in their caring career. Therefore, their dependants' early medical contact with their general practitioner or hospital specialist was seen by carers as a crucial point at which their own needs for information and help could be recognized. Other opportunities for health professionals to help carers related to involving carers in case management, the provision of counselling and training carers to provide care themselves. CONCLUSION: Many of the needs described by carers were of a social nature. However, carers also described needs relating to the health services--health professionals need to be proactive in recognizing carers' health and information needs and are required to recognize carers' contribution to the welfare of their dependant. In Fife, a multi-faceted approach was used to meet these needs. The challenge for the health service is to find a way to do this at a national level.

Adolescent↗

PubMed2006

Prevalence and associated factors of spiritual needs among patients with cancer and family caregivers.

PURPOSE/OBJECTIVES: To measure the prevalence of spiritual needs and identify factors associated with spiritual needs among patients with cancer and family caregivers. DESIGN: Descriptive, cross-sectional, quantitative. SETTING: Inpatients and outpatients at a university medical center in the southwestern United States. SAMPLE: 156 patients with cancer and 68 family caregivers who were primarily white and Christian and mostly perceived their cancer as not life threatening. METHODS: Self-report questionnaires, including the Spiritual Interests Related to Illness Tool and Information About You. Statistical analysis involved analyses of variance, correlations, and factor analysis. MAIN RESEARCH VARIABLES: Spiritual needs and desire for nursing help with spiritual needs. FINDINGS: The most important spiritual needs included being positive, loving others, finding meaning, and relating to God. The least important were needing to ask "why" questions and preparing for dying. Desire for nursing assistance with spiritual needs was moderate and varied. Variables correlated with spiritual needs and desire for nurse help included religiosity, being an inpatient, and perceiving the cancer as incurable. Desire for nurse help and importance of spiritual needs were directly correlated. CONCLUSIONS: Distressing spiritual needs were reported least frequently. Certain factors appear to be associated with how much spiritual need is perceived and how much nurse help with those needs is wanted. IMPLICATIONS FOR NURSING: Patients with cancer and family caregivers have similar spiritual needs that may require care. Spiritual assessment and therapeutics can target specific types of spiritual needs. A nurse's help with spiritual needs, however, is not always wanted.

Adult↗

PubMed1999

The needs of the family of critically ill neurosurgical patients: a comparison of nurses' and family members' perceptions.

In this study, researchers identified the important needs of family members of critically ill neurosurgical patients and explored the relationship between needs and unmet needs as perceived by nurses and family members. A total of 52 family members and 36 nurses in three neurosurgical special care units in Hong Kong were asked to complete the Chinese version of the 45-item Critical Care Family Needs Inventory. The rank order of most important needs reported by family members indicates that the majority of needs are related to assurance; needs for support and comfort were much less important. When rating needs, nurses underrated most of the needs considered important by family members. Needs for proximity were also underrated in importance by nurses when compared to family ratings, and needs for support were heavily overrated by nurses. The needs for proximity were least met. An inverse relationship between nurses' ratings of importance and the frequency of unmet needs was demonstrated. The most important need that was also largely unmet was having a specific person call when unable to visit. The findings of this study indicate areas of unmet need that require additional nursing interventions.

Adolescent↗

PubMed1998

Information needs of husbands of women with breast cancer.

PURPOSE/OBJECTIVES: To identify and measure the information needs of the husbands of women newly diagnosed with breast cancer and to determine the extent to which these needs are being met. DESIGN: Descriptive survey. SETTING: Five surgical inpatient units at four urban hospitals in Winnipeg, Manitoba, Canada. SAMPLE: 84 husbands of women recently diagnosed with breast cancer. METHOD: Subjects completed the Family Inventory of Needs--Husbands. MAIN RESEARCH VARIABLES: Information needs and extent to which these needs were met. FINDINGS: Husbands' highest ranked needs were those related to immediate care needs and communication issues. Their lowest ranked needs were those related to family relationship issues and their practical involvement in caring for their spouse. No differences existed between type of surgery (lumpectomy versus mastectomy) and number of needs and whether or not needs were met. However, husbands whose wives had undergone their first mastectomy reported approximately three times more unmet needs than husbands whose wives had undergone previous surgery for breast cancer. Husbands at greatest risk for not having their needs met were those whose occupational classification was listed as retired or laborers, those with less than a high school education, and those whose wives had only undergone one surgery for breast cancer. CONCLUSIONS: Results of this study provide a profile of the husbands' most and least important information needs and the degree to which these important needs were met. IMPLICATIONS FOR NURSING PRACTICE: With a clearer idea of the type of information important to husbands of women with breast cancer, intervention studies to determine how to best address these information needs can be designed.

Adult↗

PubMed1999

Treatment of premature ejaculation with paroxetine hydrochloride as needed: 2 single-blind placebo controlled crossover studies.

PURPOSE: We evaluate the efficacy of paroxetine hydrochloride as needed for the treatment of premature ejaculation. MATERIALS AND METHOD: Study 1 comprised 26 potent men with a mean age of 39.5 years with premature ejaculation who were randomized to receive 20 mg. oral paroxetine (group A) or placebo (group B) as needed 3 to 4 hours before planned intercourse in a controlled single-blind crossover trial. Study 2 comprised 42 potent men with a mean age of 40.5 years with premature ejaculation who were randomized to receive 10 mg. paroxetine daily for 3 weeks and then 20 mg. paroxetine as needed (group C) for 4 weeks or placebo daily for 3 weeks and then placebo as needed (group D) for 4 weeks. RESULTS: Mean pretreatment ejaculatory latency time was 0.3 minute for study 1. At 4 weeks mean ejaculatory latency time was 3.2 minutes in the paroxetine as needed and 0.45 in the placebo as needed phase for group A (p < 0.001), and 0.6 in the placebo as needed and 3.5 in the paroxetine as needed phase for group B (p < 0.001). There were no adverse effects with paroxetine or placebo in study 1. Mean pretreatment ejaculatory latency time was 0.5 minute for study 2. At 3 weeks mean ejaculatory latency time was 4.3 minutes in the paroxetine daily and 5.8 in the paroxetine as needed phase, and 0.9 in the placebo daily and 0.6 in the placebo as needed phase for group C (p < 0.001). At 3 weeks mean ejaculatory latency time was 0.8 minutes in the placebo daily and 1.1 in the placebo as needed phase, and 3.3 in the paroxetine daily and 6.1 in the paroxetine as needed phase for group D (p < 0.001). Adverse effects in 7 of 42 men (17%) given paroxetine daily included an ejaculation in 3, anorexia in 1, gastrointestinal upset in 3 and reduced libido in 2. Mean ejaculatory latency time was greater in the paroxetine as needed phase of study 2 than that of study 1 (p < 0.05), suggesting that ejaculatory control achieved with paroxetine as needed is significantly better if patients are initially treated with the drug daily. CONCLUSIONS: Paroxetine appears to be superior to placebo in the pharmacological treatment of premature ejaculation when administered on a chronic or as needed basis.

Adult↗

PubMed2006

The needs of older people with dementia in residential care.

BACKGROUND: People with dementia often move into care homes as their needs become too complex or expensive for them to remain in their own homes. Little is known about how well their needs are met within care homes. METHOD: The aim of this study was to identify the unmet needs of people with dementia in care and the characteristics associated with high levels of needs. Two hundred and thirty-eight people with dementia were recruited from residential care homes nationally. Needs were identified using the Camberwell Assessment of Needs for the Elderly (CANE). RESULTS: Residents with dementia had a mean of 4.4 (SD 2.6) unmet and 12.1 (SD 2.6) met needs. Environmental and physical health needs were usually met. However, sensory or physical disability (including mobility problems and incontinence) needs, mental health needs, and social needs, such as company and daytime activities, were often unmet. Unmet needs were associated with psychological problems, such as anxiety and depression, but not with severity of dementia or level of dependency. CONCLUSION: Mental health services and residential home staff need to be aware that many needs remain unmet and much can be done to improve the quality of life of the residents with dementia.

Aged↗

PubMedDate not supplied

Are there unmet family planning needs in Europe?

CONTEXT: The measurement of unmet need for family planning--the discrepancy between individuals' sexual and contraceptive behavior and their stated fertility preferences--has generally focused on developing countries. There has so far been little effort to measure how low unmet family planning needs can go in more developed countries, where contraceptive practice is supposedly (nearly) perfect. METHODS: Data were taken from Fertility and Family Surveys (FFS) conducted in recent years in selected member states of the United Nations Economic Commission for Europe, and minimum and maximum estimates of unmet need were calculated for 10 countries with the requisite data. RESULTS: The proportion of individuals with an unmet need for family planning (i.e., who have a current unwanted pregnancy or who are fecund, are sexually active, want no more births but are not using contraceptives) is as low as 3% in two European countries and below 10% in most. However, levels of unmet need in countries with economies in transition (13% in Latvia and Lithuania and 23% in Bulgaria) surpass some of the lowest levels observed for developing countries. Considerable within-country variations are seen. For instance, unmet need is more prominent among men than among women in seven of the nine countries for which there are data. Moreover, unmet need increases with family size and with age, suggesting an unmet need for limiting rather than for spacing births. In all of the countries except Hungary, unmet need is higher among those in marital unions than among those in less formal relationships. Level of education is another important dimension of unmet need, with less-educated respondents having the highest level of unmet need in nine of the 10 countries. Multivariate analyses confirm most of these results. Moreover, there is a clear association between unmet need and abortion ratios: Where levels of unmet need are high, the number of abortions per 100 live births is also relatively high. CONCLUSIONS: Data on unmet need, supplemented with information on induced abortion and related issues, could provide countries in Europe with useful inputs for formulating and implementing responsive reproductive health policies and programs.

Contraception Behavior↗

PubMed2006

Perceived need for alcohol, drug, and mental health treatment.

BACKGROUND: To investigate determinants of perceived need for alcohol, drug, and mental (ADM) health treatment and differences in ADM treatment patterns between individuals with perceived need and those without. METHODS: We used data from a nationally representative telephone survey of 9585 adults conducted in 1997-1998. Logistic regression was used to study the determinants of perceived need and the correlation between perceived need and any ADM treatment, specialty ADM treatment, appropriate care, and medication adherence. RESULTS: Just fewer than 37% of individuals with an ADM disorder perceived a need for treatment, while 4.6% of those without an ADM disorder perceived a need for treatment. Women, the young and middle aged, the better educated, those with greater emotional support, and those with greater psychiatric morbidity were more likely to perceive need for ADM services. Perceived need was strongly correlated with receiving ADM treatment, although almost 44% of individuals in ADM treatment did not perceive a need for treatment. Among individuals in ADM treatment, those with perceived need were significantly more likely to receive specialty ADM treatment, but not more likely to be treatment adherent, or to receive appropriate care. CONCLUSION: Substantial levels of unmet need are likely to persist as long as perceived levels of need remain low. Interventions targeting perceived need may hold promise for decreasing unmet need.

Alcoholism↗

PubMed2001

An exploration of help-seeking behaviour in older people with unmet needs.

BACKGROUND: Despite decades of research showing high rates of unmet need in older people, there currently is little understanding of why these needs remain unmet. This study was performed as part of a larger feasibility study of a multidisciplinary needs assessment tool in primary care. OBJECTIVE: The aim of the present study was to explore patients' and carers' help-seeking behaviour and perceived barriers to meeting unmet needs. METHOD: Four general practices were selected purposefully in inner city and suburban London A random sample of 1 in 20 people aged 75 years and over registered with each practice was selected for a multidisciplinary needs assessment using the 'Camberwell Assessment of Need for the Elderly' (CANE) schedule and unmet needs identified by patients and their informal carers. For each unmet need, a further semi-structured interview was used to explore the help-seeking behaviour and perceived barriers to meeting their needs. Responses were recorded verbatim contemporaneously and a thematic analysis performed on perceived barriers following completion of all interviews. RESULTS: A total of 55/84 (65.5%) of patients and 15/17 (88%) of carers completed the initial needs assessment. For 104 unmet needs identified by 31 patients and 11 carers, a further interview was completed on the barriers to meeting that need. Help had been sought for only 25/104 (24%) of unmet needs and it had been offered in only 19/104 (18%). In those not seeking help, withdrawal, resignation and low expectations were dominant themes. In those that had sought help, there were issues of perceived failure of service delivery and rationing, with themes of resignation and withdrawal again emerging in those declining help offered. CONCLUSION: The majority of older people and their carers do not appear to seek help for their unmet needs for a range of complex reasons, often involving issues of withdrawal, resignation and low expectations. This complexity has implications for the commissioning of services for older people.

Activities of Daily Living↗

PubMed1997

Needs assessment and palliative care: the views of providers.

BACKGROUND: A key element within the programme of reform introduced into the UK National Health Service in the 1990s has been the concept of health needs assessment, which must be undertaken by health care purchasers as a guide to the planning process. As part of a wide-ranging study of the impact of the NHS reforms on hospices and specialist palliative care services, providers' perceptions of needs assessment for palliative care were examined, including the extent to which needs assessments had been carried out in local districts, together with the implications. METHODS: The study comprised two key elements. In spring 1995 a postal survey was conducted among all UK hospices and specialist palliative care in-patient units (n = 203) eliciting factual information concerning needs assessment and contracting, together with perceptions and evaluations of the local impact of the NHS reforms. A total of 128 (63 per cent) questionnaires was completed and returned. In addition to the survey, 12 case studies were conducted with a stratified random sample of NHS, independent and large or small hospices and specialist palliative care units. Each of the 12 case study sites was visited by a member of the research team, who conducted interviews with senior staff and analysed financial, planning and management data. Thus the survey allowed a wide analysis of the impact of the NHS reforms, which was enhanced by the more in-depth qualitative data gathered from the case studies. RESULTS: In the survey 49 per cent of those responding reported that their main purchaser had conducted a needs assessment for palliative care in the last five years. Palliative care needs assessment was seen as valuable by providers: 73 per cent considered it very important and 28 per cent of hospices had gone so far as to request a needs assessment from their health authority. In an open-ended question seeking views on the impact of health needs assessment, 66 per cent of those responding (71/107) stated that the impact had been or would be positive. The case studies, however, revealed a more mixed picture. The 12 hospices or specialist palliative care units had contracts with a total of 24 health authorities, 12 of which had conducted some type of needs assessment for palliative care. On close examination the comprehensiveness of these was questionable. Few providers had participated in the design and there were low levels of knowledge about the findings. High expectations of the value of needs assessment were often not fulfilled. There was also a tendency for providers to view needs assessment in a purely instrumental light, as a vehicle to further promote their own interests. CONCLUSIONS: Palliative care needs assessment has considerable potential to influence future purchasing and service provision, yet not all health commissions are undertaking it. There is a high level of provider enthusiasm for palliative care needs assessment, albeit coupled to low levels of technical knowledge and a lack of involvement in the process at local level. Purchaser-provider dialogue on needs assessment should focus on both raising awareness of appropriate techniques and debating 'ethical neutrality' about the outcome.

Attitude of Health Personnel↗