Needs Assessment Tool for Palliative Care

Ask: Is the patient satisfied with the current support, or is significant unmet distress or concern evident? 'Fully met' = patient and family feel adequately supported in that domain. 'Partially met' = some support exists, but patient/family perceive gaps (e.g., pain somewhat controlled but still present; family receives monthly counseling but needs weekly support). 'Unmet' = patient/family explicitly identify a need with no current support (e.g., pain not addressed, no chaplaincy referral, financial crisis untouched). When uncertain, ask: 'Is there anything more you need in [domain] that would improve your quality of life?'—their answer clarifies the classification.

Assess during hospitalization (at or shortly after admission) so urgent unmet needs can be addressed before discharge. Repeat at discharge and again 1 week post-discharge, as new needs often emerge at home (transportation barriers, unaffordable medications, inadequate home care). A transition care coordinator or palliative care nurse should follow up within 48 hours of discharge to address discharge-related needs.

Respect autonomy; document their refusal and the reason (e.g., 'Declined chaplaincy referral; states no spiritual distress'). However, offer support repeatedly—patients' attitudes change as illness progresses. A patient who declined counseling in week 1 may welcome it after acute decline in week 3. Re-offer at each reassessment; do not remove support from the care plan simply because it was initially refused.

The NAPC was developed in cancer palliative care but is applicable to all progressive life-limiting illnesses: heart failure, COPD, organ failure, neurological disease, dementia, AIDS. Domains remain consistent, though disease-specific needs may be emphasized (e.g., in dementia, 'family education on behavioral changes' becomes more salient; in heart failure, 'information about symptom triggers' is crucial). Adapt the NAPC to your population's key concerns.