• Karen G Scandrett, Eva B Reitschuler-Cross, Lauren Nelson, J Alex Sanger, Maia Feigon, Elizabeth Boyd, Chih-Hung Chang, Judith A Paice, Joshua M Hauser, Alexey Chamkin, Paul Balfour, Alexei Stolbunov, Charles L Bennett, and Linda L Emanuel.
• Buehler Center on Aging, Health and Society, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. kgscandrett@northwestern.edu
• J Palliat Med. 2010 Feb 1;13(2):161-9.

BackgroundA comprehensive whole-person approach might improve processes and outcomes of care for patients with cancer.ObjectiveTo assess the ability of NEST13+ (Needs of a social nature; Existential concerns; Symptoms; and Therapeutic interaction), a screening and assessment tool, to identify social, emotional, physical, and care-system needs and to improve clinical outcomes for cancer patients in tertiary care.Design, Setting, PatientsA controlled trial involving 451 patients hospitalized for cancer care at a comprehensive cancer center.InterventionPatients responded to 13 screening questions regarding possible care needs. When an individual response exceeded threshold levels, additional in-depth questions for the relevant need were asked. For patients in the intervention arm, clinical recommendations for each dimension of need were generated based on a previously developed NEST-response-driven menu, and were reported to the clinical team.MeasurementsDocumented needs, clinician response, patient perception of goals alignment, and overall quality of palliative care.ResultsUsing the NEST13+ tool in the clinical setting facilitated greater documentation of illness-related needs than routine clinical assessment. Improvement in secondary outcomes was attenuated: changes in the clinician response were modest; changes in outcomes were not significant.ConclusionThe NEST13+ tool facilitated identification of a wider range of important needs than traditional evaluation, while care outcomes were not improved. Traditional evaluation may need improvement. Future trials of the NEST13+ should focus on more intensive clinician-directed interventions.

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