The implementation and impact of Holistic Needs Assessments for people affected by cancer: A systematic review and thematic synthesis of the literature.

Objective: Globally, cancer services herald the use of Holistic Needs Assessments (HNA). Implementation is, however, heterogeneous. There is a need to understand what effect implementation variation has on patient experience, outcomes and service demand. This is the first study to examine whether the way in which HNA is implemented, impacts on patient outcomes.

Methods: MEDLINE, AMED, CINAHL, PsycINFO and the Psychological and Behavioural Sciences Collection were searched (June 2000-June 2018). Search strategy included international HNA tools and synonyms for "needs." An overview of quality was obtained through application of the Mixed Methods Appraisal Tool. Key themes were identified through thematic synthesis.

Results: Twenty studies were included (RCTs [n = 4], service evaluations [n = 8] and feasibility studies [n = 8]). Implementation approaches and assessor actions were identified and through thematic synthesis were defined as detecting, discussing/dealing, directing and downstream care. The way in which HNA is implemented is more important to understanding outcomes than what is implemented.

Conclusion: There is a need to conceptualise HNA as a means and not an end in itself. Pursuers of HNA-led outcomes must understand and strengthen connections between assessment and outcomes. The conceptual framework can assist development of more insightful measures of both process and outcomes.