Development of a Revised Clinical Guide to Multidimensional Needs Assessment in Palliative Care: MAP.

CONTEXT: Needs assessment in palliative care is essential for drawing up personalized care plans that improves the quality of life of the patient and their family by preventing and alleviating suffering and addressing unmet needs. Our group recently developed a guide to Multidimensional needs Assessment in the Palliative care initial encounter (MAP), and its applicability in different care settings has been confirmed. However, the professionals consulted also suggested a number of possible improvements for its implementation in clinical practice.

OBJECTIVES

To refine the MAP clinical interview guide through expert consensus.

METHODS

Twenty-two palliative care physicians who had previously implemented MAP participated in a two-round Delphi study conducted in accordance with the CREDES guidelines. The threshold for consensus was set at 80% agreement among panellists. The Delphi findings were subsequently discussed by a nominal group of 10 (different) palliative care experts to achieve a final consensus, following the four-step meeting process described by Van de Ven and Delbecq. Consensus was sought on the removal of less frequent needs and including the assessment of advance directives and wish to hasten death.

RESULTS

The revised version of the MAP guide comprises 48 needs. It was agreed that advance directives and a possible wish to hasten death should be added to the domain relating to spiritual/existential concerns, and also that less frequent physical symptoms (e.g., pruritus, myoclonus) and the use of complementary therapies should be retained in the guide. Experts also stressed the importance of concluding the initial assessment by returning to the patient's main concerns and prioritizing their most urgent needs.

CONCLUSION

The revised MAP guide incorporates advance directives and a possible wish to hasten death as key issues to explore, reinforcing its utility as a tool for the comprehensive assessment of patients' needs in the palliative care initial encounter. Its use may support the development of individualized care plans and future research should explore its applicability and benefits in clinical practice.