Palliative Medicine

http://pmj.sagepub.com A practical instrument to explore patients' needs in palliative care: the Problems and Needs in Palliative Care questionnaire short version
Bart H.P. Osse, Myrra J.F.J. Vernooij-Dassen, Egbert Schad and Richard P.T.M. Grol Palliat Med 2007; 21; 391 DOI: 10.1177/0269216307078300 The online version of this article can be found at: http://pmj.sagepub.com/cgi/content/abstract/21/5/391

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Palliative Medicine 2007; 21: 391399

A practical instrument to explore patients needs in palliative care: the Problems and Needs in Palliative Care questionnaire short version
Bart HP Osse and Myrra JFJ Vernooij-Dassen Centre for Quality of Care Research (WOK) University Medical Centre St Radboud, Nijmegen, Egbert Schad Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam and Richard PTM Grol Centre for Quality of Care Research (WOK) University Medical centre St Radboud, Nijmegen Objective: Short and convenient checklists are necessary tools to support and structure needs assessments in daily palliative practice. This study aims to develop a short version of the Problems and Needs in Palliative Care questionnaire (PNPC-sv); a self-report questionnaire for patients covering all dimensions of palliative care, to investigate their problems and (unmet) needs. Methods: The original Problems and Needs in Palliative Care questionnaire (PNPC) instrument is a comprehensive checklist of problems and needs for palliative care, and has shown validity and reliability. With its 90 items, however, it is not always practical. Thus it was abridged to a short version with 33 items. The validity and reliability are established with its item response, its internal consistency, and with its correlations with the original PNPC and with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and COOP/WONCA quality-of-life measures. A secondary analysis was done with data from 94 patients with metastatic cancer who had completed the long version. Results: Each item in the PNPC represents a problem relevant to 25% of the patients or more. High correlations of PNPC-sv and PNPC domains demonstrate construct validity. The dimension reliability was satisfactory (Cronbachs 0.70), while two problem-aspect domains were less coherent. The PNPC-sv domains show convergent validity with corresponding health-related quality-of-life domains. Conclusion: The PNPC-sv is a concise, patient-centred tool that helps to identify the problems affecting the patients quality of life and needs for care. It identies prevalent needs for care and appears reliable. Further research should study the clinical effects of integrating the questionnaire into daily palliative-care practice. Palliative Medicine 2007; 21: 391399

Introduction
A proper assessment of the problems and needs that patients experience is a crucial aspect of appropriate palliative care. To achieve the purpose of palliative care, which is to optimize the patients well being, it is essential to tailor palliative care to the patients personal needs.1 Interactive needs assessment may help to empower the patient and involve the patient and their family in decisions. Despite the need for individualized care, there are quite a few advantages to using standardized instruments like questionnaires, to assist in assessing these individual needs. Such instruments provide structure to the needs-assessment and assure that relevant topics are addressed.2,3 They may also help professionals to access unfamiliar territories of need and to overcome barriers to address sensitive issues. Professionals may save time if patients complete self-report needs-assessment questionnaires before a consultation at

Address for correspondence: Bart HP Osse, P.O. Box 9101, Internal code: 114 KWAZO, 6500 HB Nijmegen, The Netherlands. E-mail: B.Osse@kwazo.umcn.nl/Osse-arentz@home.nl
2007 SAGE Publications

their own pace, while comprehensive assessments are still being made. The other advantage to this is that patients who have spent time thinking over their personal issues, are better prepared for a meeting with their physician. Instruments that provide structured and detailed information about the patient can be transferred easily to inform other professionals involved where professionals work cooperatively, eg, in outpatient settings. Repetitive use of standardized assessments enables follow-up of problems through time, and provides information for quality improvement in palliative care. Standardized assessments also generate standardized data, which is important for scientic research in palliative care. Recently, new instruments have been developed specically for the clinical purpose of needs assessment in palliative care.46 The Problems and Needs in Palliative Care questionnaire (PNPC) is a ne example of this important development.7 However, because this instrument is a comprehensive checklist of patients potential problems and adjacent unmet needs for care,8 it is rather long. In some settings this may impede practical use and further implementation. To overcome feasibility issues a shorter instrument may be necessary. This paper describes the development of a short version of the PNPC questionnaire and aspects of its validity and reliability.
10.1177/0269216307078300

Downloaded from http://pmj.sagepub.com by Oana Donea on November 22, 2007 2007 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution.

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