Values Assessment Tools in Advanced Cancer: A Clinical Literature Review.

BACKGROUND: Patients with advanced cancer may receive cancer treatment that does not reflect their values because they may not be completely aware of what is important to them regarding treatment-related decisions when they are diagnosed. OBJECTIVES: The purpose of this review was to determine whether existing values assessment tools can improve awareness of treatment-related decisional values in patients with advanced cancer. METHODS: PubMed®, CINAHL®, and PsycINFO® databases were searched for original English-language articles evaluating values assessment tools that could be used to assess patients with advanced cancer. The quality of the identified tools was evaluated using selected International Patient Decision Aid Standards instrument, version 3.0, criteria. FINDINGS: All tools identified are appropriate for use in patients with advanced cancer. Two scored at least 80% on the selected International Patient Decision Aid Standards criteria. The Short Graphic Values History Tool was developed with patient and clinician input and may be particularly useful for low-literacy patient populations with advanced cancer. No values assessment tools have been identified specifically for use in patients with advanced cancer.

Screening for the social determinants of health: Referring patients to community-based services.

BACKGROUND: Screening patients for the social determinants of health (SDOH) allows clinicians to identify those needs and tailor referral efforts. Due to constraints on clinic time and monetary resources, a simple screening tool incorporated into existing clinic workflow increases its usefulness and impact. LOCAL PROBLEM: Our free, nurse-led, mobile health clinic (MHC) needed an enhanced process or tool for screening patients for SDOH. The purpose of this quality-improvement project was to screen adult patients in the MHC for SDOH needs and to increase volunteer staff perceptions of their knowledge and confidence in referring patients to relevant community-based services. METHODS: A screening process and tool was developed using guidelines from the Health Leads to identify patients' SDOH needs and related requests for assistance. The tool was introduced to and tested among volunteer staff through pretest/posttest surveys. INTERVENTIONS: Patients who visited the clinic were screened for the SDOH within the project period, and volunteer staff were surveyed about their perceptions of the screening tool. RESULTS: Sixty-four patients were screened for SDOH needs. Twenty-three percent reported food insecurity, 27% housing insecurity, 14% difficulty obtaining utilities, and 17% difficulty obtaining transportation; 28% requested assistance with their reported SDOH needs. Seventeen percent of patients reported two or more SDOH needs. At posttest, 100% of volunteer staff ( N = 9) indicated satisfaction with the SDOH screening questions, reported feeling knowledgeable about resources to use for patient referrals, and were confident in referring patients to needed resources. CONCLUSION: The screening tool aptly guided practice and was evaluated as "easy to use" for clinic patients and volunteer staff.