Top ten concerns burdening people with cancer: perceptions of patients with cancer and the nurses caring for them

Purpose We examined the concerns that nurses perceive patients to have, whether these are
congruent with patients’ concerns and whether they vary according to cancer site. We also
examined Distress Thermometer scores according to cancer site.
Method A cross-sectional survey design: (i) secondary analysis of an existing Holistic Needs
Assessment (HNA) and Distress Thermometer (DT) dataset was used, (ii) a survey of
specialist nurse teams to identify their perceptions of patient concerns. Data collected
between January 2015 and June 2016 from the HNA database for one NHS Trust in England
(n=1233 patients). Specialist nurse teams for breast, colorectal, gynaecology, skin and
urology cancers identified the concerns that they perceived their patients would report.
Results The HNA showed high internal consistency (Cronbach’s alpha 0.86). Across the five
cancer sites, nurses identified between 3 and 6 of the top ten concerns (TTC) expressed by
patients, with wide variation across sites. Nine of the TTC were significantly associated
(p<0.05) with a specific cancer site. The breast and gynaecological cancer groups both
recorded significantly higher median Distress Thermometer scores than the urology, skin and
colorectal cancer groups (Kruskall-Wallis 
2
(4, n=1228) 186.695, p=<.01).
Conclusions: One of the aims of the eHNA is to enable service delivery appropriate to
patient needs. Our findings suggest that this will only be achieved if eHNA is examined, and
services developed, by individual cancer site. The misconception of patient needs by
specialist nurses underscores the importance of review of information provided by patients
during consultations.