A systematic review of the implementation of cancer-specific holistic needs assessment (HNA) in adult clinical practice, and applicability to the brain tumour population
Clinical Snapshot
PICO Framework
| P — Population | Adults with cancer, with specific focus on brain tumour patients |
| I — Intervention | Holistic needs assessment (HNA) tools |
| C — Comparator | Standard care or other needs assessment approaches |
| O — Outcomes | Implementation success, patient satisfaction, staff satisfaction, identification of physical and psychosocial needs |
Bottom Line
This systematic review highlights a significant evidence gap in holistic needs assessment implementation for cancer patients, particularly those with brain tumours. Despite identifying four HNA tools across nine studies, the evidence for successful clinical implementation remains limited and inconsistent. Patients tend to report physical needs more readily than psychosocial needs, and there's insufficient evidence regarding patient and staff satisfaction. Only one study specifically adapted HNA for brain tumour patients, representing a critical gap given this population's complex and unique needs. The varied evidence regarding timing, location, and delivery methods suggests implementation challenges that require addressing. For Australian clinicians, this review underscores the need for evidence-based guidance before widespread HNA adoption in brain tumour care. While the concept of holistic needs assessment aligns with patient-centred care principles, current evidence is insufficient to recommend specific implementation strategies. Further research is needed to develop brain tumour-specific HNA tools and establish clear implementation protocols before routine clinical adoption.
Key Findings
P Value: Not applicable - qualitative synthesis
Effect Size: Not quantified - narrative synthesis only
Primary Outcome: Limited evidence of successful HNA implementation in clinical practice
Nnt Or Sensitivity: Only one study adapted specifically for brain tumour patients
Confidence Interval: Not reported
Clinical Application
Current evidence suggests implementation challenges exist across timing, location, and delivery modes Relevant to Australian cancer care given similar healthcare delivery models, though local adaptation would be needed for successful implementation Adult cancer patients, particularly those with brain tumours requiring comprehensive needs assessment
Abstract
PURPOSE: This review aimed to identify and review any brain tumour-specific holistic needs assessment (HNA) and the clinical implementation of any HNAs in an adult cancer population. METHODS: A systematic review and narrative synthesis. Five electronic databases were searched from 2008 to 2023 and updated in January 2025. Reference lists of systematic reviews were screened for relevant studies. Two independent reviewers performed study selection, critical appraisal, and data extraction. RESULTS: Four HNA tools implemented in clinical practice, across 9 studies, were included. One study was adapted for brain tumour patients. Evidence of widespread implementation in clinical practice was limited and varied evidence, relating to the timing, location and mode of delivering. Patients were more likely to report on physical rather than psychosocial needs, with limited evidence of patient and staff satisfaction with the use of HNA. CONCLUSION: There is limited and varied evidence of HNAs being successfully implemented in brain tumour and the wider cancer healthcare settings. Tailored interventions for the needs of people with brain tumour have the potential to address the complexities this population faces. However, clear evidence-based guidance to develop relevant HNAs for successful implementation in clinical settings is needed.
References
- 1.Sivell, S., Hamilton, T., Mann, M., Baddeley, E., Bulbeck, H., Retzer, A., Seddon, K., & Byrne, A. (2026). A systematic review of the implementation of cancer-specific holistic needs assessment (HNA) in adult clinical practice, and applicability to the brain tumour population. Supportive Care in Cancer. https://doi.org/10.2147/PROM.S179313
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