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Author Claire Taylor, Macmillan’s Chief Nursing Officer and Clair Le Boutillier, Occupational Therapist and THIS Institute Research Fellow, who leads the HNA/eHNA study
Categories Adult Social Care, Personalised Care
Resource type Blog
Publishing body Macmillans

Putting the person in personalised care: what patients say about the HNA

Nurse talking to patient

Holistic assessments, such as the Holistic Needs Assessment (HNA), personalise care by offering the opportunity for patients to work in partnership with clinicians to identify needs and goals that are most important to them. Electronic versions (such as the eHNA) allow for digital personalised care and support. This blog is an opportunity to demonstrate Macmillan’s engagement with research particularly in terms of listening to the experiences of patients and staff and making healthcare improvements.

Making sense of the HNA: Reflecting on patient experience

A study that explores the experience of the HNA/eHNA is underway. Funded by THIS (The Healthcare Improvement Studies Institute) Institute and hosted by King’s College London, the aim is to understand how personalised care and support planning in the form of the HNA/eHNA works (or not) from the perspectives of people who are living with colorectal cancer, and their clinicians. The research will go on to co-design improvements with patients and clinicians. The study focuses on the HNA/eHNA at diagnosis (as its starting place) due to the need to place restrictions on the research sample.

The research is following five colorectal cancer teams (across three NHS Trusts) as they complete the HNA/eHNA process from service offer to personalised care and support planning meeting. While the intervention is tailored differently (in terms of process, timing, and modes of delivery) across teams, it typically involves:

  1. Each patient being invited to complete a paper (HNA) or web-based (eHNA) tool to identify and rate concerns in different areas of their life (the concerns checklist), and to answer six ‘what matters to you’ personalised care questions.
  2. Responses are used to support clinicians to structure a conversation  (the personalised care and support planning meeting (either face-to-face, by telephone or video call)) that focuses on what is important to each patient.

The study has, so far, followed nine patients. This has involved videoing each patient at three time points to capture their experience of i) using the HNA/eHNA tool, ii) the personalised care and support planning meeting with their clinician and iii) to review footage from the previous two videos and to gather feedback on their HNA/eHNA experience. Clips from the patient videos are then edited into one short film and shared with each patient’s paired clinician and their wider team to allow them to reflect on real-time practice, to identify good practice and to consider areas for improvement (Iedema et al., 2019).

Clinicians explained that watching the patient films challenged their perception of practice and made them reconsider the value of the HNA/eHNA as something meaningful and more than a tick-box exercise.