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217
Evaluation of an Instrument to Assess the Needs of
Patients with Cancer
Billie Bonevski, Ph.D.
Rob Sanson-Fisher, Ph.D.
Afaf Girgis, Ph.D.
Louise Burton, M.Mgt.(Health)
Peter Cook, B.E.
Allison Boyes, M.P.H.
the Supportive Care Review Group
This research was undertaken by the New South
Wales (NSW) Cancer Council Supportive Care Review Group and the Cancer Education Research
Program, directed by Professor Rob SansonFisher, Ph.D., until to November 1997. The Supportive Care Review Group includes Stephen Ackland, M.B.B.S., Robin Baker, Dip.Soc.Studs.,
Martin Berry, M.B.B.S., James Biggs, Ph.D., Jim
Bishop, M.D., Les Bokey, M.S., Alison Burnard,
R.N., Cert.M., Philip Clingan, M.B.B.S., Patrick
Cregan, M.B.B.S., Stewart Dunn, Ph.D., Michael
Friedlander, Ph.D., Kerry Goulston, M.D., Neville
Hacker, M.D., John Kearsley, Ph.D., Allan Langlands, M.B.Ch.B., John Levi, M.D., Eugene Moylan,
M.B.B.S., John Stewart, M.B.B.S., and Martin Tattersall, M.D. The views expressed are not necessarily those of the Cancer Council.
The authors thank the staff of the participating
hospitals for their assistance and cooperation in
carrying out the project, and also Janet Anthes,
Adam McLean for his assistance in undertaking
this research, and Ian Clare and Ross Corkrey for
statistical advice and support.
Address for reprints: The Secretary, NSW Cancer
Council Cancer Education Research Program,
Locked Bag 10, Wallsend NSW 2287, Australia.
Received June 28, 1999; accepted September 2,
1999.
© 2000 American Cancer Society
BACKGROUND. This study aimed to assess the face, content, and construct validity
and the internal reliability of a tool for assessing the generic needs of patients with
cancer (the Supportive Care Needs Survey).
METHODS. A total of 1492 consecutive patients attending the surgical, radiation, or
medical oncology departments of 9 cancer treatment centers in New South Wales,
Australia, were asked to participate. Of the 1370 eligible patients, 1354 (99%)
consented to participate and 888 (65%) completed the survey. Eligible consenting
patients were given a Supportive Care Needs Survey to complete at home and
return by mail within 7 days.
RESULTS. In the assessment of construct validity, the principal components
method of factor analysis identified 5 factors with eigenvalues greater than 1,
which together accounted for 64% of the total variance (patients’ needs in the
domains of psychologic, health system and information, physical and daily living,
patient care and support, and sexuality). Face and content validity were found to
be high following pilot tests and tests of reading ease. Internal reliability coefficients (Cronbach alpha) of all 5 factor-based scales were found to be substantial,
ranging from 0.87 to 0.97.
CONCLUSIONS. These findings suggest that the Supportive Care Needs Survey
provides a reliable and valid index of the global needs of oncology patients. The
standardized and widespread application of this instrument is recommended
following further refinement and evaluation. [See related article on pages 226237,
this issue.] Cancer 2000;88:217–25. © 2000 American Cancer Society.
KEYWORDS: supportive care, measures, cancer, psychometrics.
ue to the rising incidence of cancer1,2 and stabilizing mortality
rates,2 the experience of living with cancer is increasingly prevalent. Research has shown that a diagnosis of cancer is often associated
with high morbidity.3–9 Three primary methodologies have been applied in the study of morbidity outcomes for cancer patients: quality
of life, patient satisfaction, and needs assessment.10 While quality-oflife evaluations have gauged the ramifications of the disease for different aspects of life experience,11–14 patient satisfaction surveys have
more closely focused on perceived quality-of-care issues.10 In contrast, needs assessment spans both quality-of-life and quality-of-care
issues when the impact of disease on patients’ needs is assessed.
Regardless of methodologies, the common goal is to acquire information about health outcomes pertinent to assisting in the improvement of the quality of patient care and the reduction of cancer-related
morbidity.15
However, unlike other methodologies, needs assessments offer a
number of advantages.10,11,16 –19 First, they enable direct assessment
of patients’ perceived needs for help, thereby allowing a more direct
D
218
CANCER January 1, 2000 / Volume 88 / Number 1
indication of needed resources. Second, they allow the
identification of the magnitude of need for help,
thereby allowing some prioritization of service needs
so that resources can be allocated where the need is
most urgent. Third, needs assessment enables the
identification of individuals and/or patient subgroups
with higher level needs, thereby potentially enabling
prevention or at least reduction of problems through
appropriate early intervention.16 –19
Despite this, the potential of needs assessment
appears not to have been met.20,21 A 1996 review of the
psychometric properties of needs assessment tools
used with oncology populations and published between 1985 and 1995 revealed that perhaps one of the
reasons need assessment has not been commonly utilized is because of a lack of quality tools.21 The review
of 71 articles rated each needs assessment tool against
6 criteria: 1) it measures the multidimensional impact
of cancer on patients’ needs; 2) it directly and comprehensively assesses subjective health-related needs
for help; 3) it measures outcomes within a defined
temporal context; 4) it demonstrates acceptable reliability and validity of assessment tools and methods;
5) it is user-friendly; and 6) it is system-friendly. The
review found that few needs assessment tools met
these criteria. A MEDLINE search of the literature
published between 1996 and 1998 failed to reveal any
advances in this area.
Arguably, one of the most critical of the criteria
outlined above is that the needs assessment instrument provide demonstrable evidence of sound psychometric properties, such as validity and reliability.22
Without such evidence, an instrument’s capacity to
assess accurately and reliably that which it is designed
to measure remains uncertain, and the resultant data
is untrustworthy.
In practice, reliability is usually defined in terms
of the consistency of scores that are obtained on the
observed variable.23 An instrument is said to be reliable if it is shown to provide consistent scores on
repeated administration or administration in different
forms.24 The most popular administration methods
are the internal consistency indices of reliability.24
One of the most widely used indexes of internal consistency reliability is coefficient alpha.25
Another critical psychometric property of an instrument is its validity, which refers to the ability of
the instrument to measure that which it is intended to
measure.23,26 Some measures of validity include face
validity, content validity, and construct validity. Face
validity refers to whether items appear to be measuring issues consistent with the purpose of the instrument.27 Content validity directly relates to the comprehensiveness of the scale and can be facilitated by
incorporating the perspectives of those who have actually experienced the problem.28 Construct validity
refers to the extent to which an instrument measures
the abstract concepts or constructs underlying the
instrument’s factors or subscales.29 This is most commonly assessed using factor analytic techniques.24
This article describes the development and psychometric evaluation of a subjective, self-administered instrument designed to measure the needs of
patients with cancer. The instrument was designed to
conform to the six criteria outlined above.21 Specifically, the study aimed to 1) assess the face, content,
and construct validity of a needs assessment tool; and
2) assess the internal reliability, using Cronbach alpha,
of a needs assessment tool.
The purpose of the instrument was to provide a
direct and comprehensive assessment of the multidimensional impact of cancer (including assessment of
health services and treatment delivery) on the lives of
generic cancer patients. It was based on an existing
Cancer Needs Questionnaire (CNQ),21,30 which assesses cancer patients’ current needs for help in multiple life areas with demonstrable reliability and validity. A priori estimates of scale constructs were based
on the following CNQ constructs: 1) psychologic
needs—assessing patients’ perceived needs for help
with psychologic and emotional issues, including
counseling and support; 2) health information
needs—information needs pertaining to diagnosis, investigative tests, psychologic issues, family issues, and
financial issues; 3) physical and daily living–physical
needs and adjustment tasks, including coping with
physical symptoms and side effects of treatment, performing usual physical tasks and activities of daily
living, and self-management of medical treatment
routines and health care at home; 4) patient care and
support—support needs of cancer patients in relation
to family, friends, and health care professionals; and 5)
interpersonal communication—interpersonal relationships and the interactional skills and communication styles of health care providers.
METHODS
Item Generation
The Supportive Care Needs Survey was adapted from
the existing CNQ,21,30 which contains a total of 52
questions with a 5-point response scale. Thus, each
item asked patients to consider their level of need for
help with the item by choosing one of the following
response options: no need—not applicable; no need—
already satisfied; low need; moderate need; or high
need. The instructions ask patients to identify needs
they may have experienced in the last month as a
result of having cancer. This instrument had been
Assessing Cancer Patients’ Needs/Bonevski et al.
pilot-tested during development and its reliability and
validity ascertained.21,30
Using the CNQ as the initial pool of items, the
survey was reviewed for appropriateness of content by
a team of experts, consisting of oncology specialists,
behavioral scientists, and consumer representatives. A
sample of 200 patients with cancer were then asked to
complete the draft survey and to provide written and
verbal comment on its relevance, appropriateness,
comprehensiveness and acceptability of items, and
ease and comprehensibly of instructions and format.
Items felt to be redundant were removed and complex
language reduced. On the basis of patient and expert
responses, a survey with 60 needs items was constructed. An additional question, stemming from the
CNQ, about patients’ desire for access to support services and people was also included.
Sample
Treatment centers
Nine major public cancer treatment centers in an
Australian state (New South Wales) participated. All
treatment centers provided surgical and medical oncology treatment facilities and six provided radiation
treatment facilities.
Patients
Respondents consisted of people diagnosed with cancer who were in consecutive attendance at either the
surgical oncology department or the medical or radiation oncology outpatients clinics at the participating
treatment centers during the survey period. Patient
eligibility criteria included being between ages 18 and
85 years, having been diagnosed with cancer at least 3
months prior to the conduct of the study, being able to
speak and write English, and being physically and
mentally willing and able to complete a written questionnaire. If patients were receiving more than one
type of treatment, they were asked to complete the
survey only once.
Procedure
After arriving at the clinic waiting room, each patient
was introduced to a trained interviewer by a nurse and
verbally informed about the study. After establishing
the patient’s eligibility to participate, the interviewer
provided written information about the survey and
asked for the patient’s written consent. All eligible,
consenting patients were given a Supportive Care
Needs Survey and a reply-paid envelope to take home.
Patients were asked to complete the questionnaire
during the following 48-hour period and return it to
the researchers by mail within 7 days. Patients who
did not return the questionnaire to the researchers
219
within 10 days received a follow-up reminder telephone call from the interviewer.
The study received approval from the New South
Wales (NSW) Cancer Council Human Research Ethics
Committee as well as the ethics committees of participating hospitals.
RESULTS
Sample
Treatment centers
Of the nine participating treatment centers, patients
were approached about the study in the surgical oncology department of one center, the radiation oncology departments of the six centers that provided it,
and the medical oncology departments of all centers.
Patients
A total of 1492 cancer patients were approached. Of
these, 122 patients were ineligible for the following
reasons: 54 (4%) were too ill to participate, 3 (,1%)
were younger than 18 or older than 85 years, 32 (2%)
did not comprehend English, and 33 (2%) had already completed the survey. Of the 1370 eligible
patients, 1354 (99%) consented to participate and
888 (65%) returned a completed survey. This provided a more than adequate sample size for the
conduct of factor analyses, which usually require a
1:5 item:respondent ratio.24 There was no significant difference between consenters and nonconsenters with regard to gender.
Table 1 shows the demographic and treatment
characteristics of participating patients in comparison
to the NSW population of cancer patients,2 as reported
by the NSW Central Cancer Registry. The study sample
overrepresented females; breast, bowel, colon, and
rectal carcinoma cases; and those between ages 31
and 60 years. Males; prostate carcinoma, lung carcinoma, and skin cancer/melanoma cases; and those
ages 71– 85 years are underrepresented in the sample
compared with the NSW cancer population.
Validity of the Supportive Care Needs Survey
Construct validity
The principal components method of factor analysis
was calculated using the SAS program, PROC FACTOR
command (SAS Institute, Cary, NC). The principal
components model enables the exploration of dimensions underlying patients’ perceptions by summarizing data into an optional number of independent factors. The program identified 5 factors with eigenvalues
greater than 1, which together accounted for 64% of
the total variance. These factors (and the proportion of
the total variance explained by each) were identified
as follows: 1) psychologic (21%)—needs related to
220
CANCER January 1, 2000 / Volume 88 / Number 1
TABLE 1
Sample Demographics and Treatment Characteristics Compared with Cancer Patients
in New South Wales, Australia
Surveys sample
(n5888)
Characteristics
Age (yrs)b
18–30
31–40
41–50
51–60
61–70
71–85
Gender
Male
Female
Marital status
Married
Defacto
Divorced/Separated
Widowed
Never married/single
Primary cancer site
Breast
Colon and rectum
Prostate
Lung
Skin/melanoma
Don’t know
Other
Treatment received in last moc
Chemotherapy
Radiotherapy
Surgical removal of cancer
Immunotherapy
Hormone treatment
Bone marrow treatment
Other
NSW 1994 (n526,186)a
No.
%
No.
%
P value
19
49
140
188
236
256
2
6
16
21
27
29
438
1,047
2,215
3,794
7,039
10,950
2
4
8
14
27
42
1.0
0.003*
,0.001*
,0.001*
1.0
,0.001*
357
484
42
58
14,869
11,317
57
43
,0.001*
,0.001*
559
30
78
98
76
66
4
9
12
9
**
280
150
80
67
43
14
217
32
17
9
8
5
2
24
3,327
3,473
4,497
2,533
2,365
1,006
8,985
13
13
17
10
9
4
34
,0.001*
,0.001*
,0.001*
0.05*
,0.001*
,0.001*
,0.001*
378
315
107
12
58
6
28
40
37
11
2
6
,1
3
**
NSW: New South Wales, Australia.
a
Coates MS, Armstrong BK. Cancer in New South Wales. Incidence and Mortality 1994. Sydney, NSW Cancer Council, 1997.
b
NSW data reported for age are based on the following age categories: 20–29, 30–39, 40–49, 50–59, 60–69, and 70–89 years.
c
%’s are proportion of total; respondents may indicate more than 1 category.
* Significant difference between study sample and NSW average.
** Comparison data not available.
emotions and coping; 2) health system and information (18%)—needs related to the treatment center and
for information about the disease, diagnosis, treatment, and follow-up; 3) physical and daily living
(10%)—needs related to coping with physical symptoms, side effects of treatment, and performing usual
physical tasks and activities; 4) patient care and support (10%)—needs related to health care providers
showing sensitivity to physical and emotional needs,
privacy, and choice; and 5) sexuality (5%)—needs related to sexual relationships.
The five factors suggest that the scale’s underlying
constructs correspond closely, although not entirely,
to those reported by Foot et al. (1996).30 Examining the
relative magnitude of each factor suggests that the
psychologic needs items and the health system and
information needs items accounted for over one-half
of the total variance.
The items and their primary factor loadings are
displayed in Table 2. The primary loadings of 4 items
were ambiguous, or failed to achieve the 0.5 cutpoint31
for inclusion.
Assessing Cancer Patients’ Needs/Bonevski et al.
221
TABLE 2
Factor Categories and Loadings
Factor
Item
Loading
Psychologic (22 items)
Fears about losing your independence
Confusion about why this has happened to you
Feeling bored and/or useless
Anxiety
Feeling down or depressed
Feelings of sadness
Fears about the cancer spreading
Fears about the cancer returning
Fears about pain
Anxiety about having any treatment
Fears about physical disability or deterioration
Accepting changes in your appearance
Worry that the results of treatment are beyond your control
Uncertainty about the future
Learning to feel in control of your situation
Making the most of your time
Keeping a positive outlook
Finding meaning in this experience
Feelings about death and dying
Concerns about the worries of those close to you
Changes in usual routine and lifestyle
Concerns about the ability of those close to you to cope with caring for you
Hospital staff to convey a sense of hope to you and your family
The opportunity to talk to someone who understands and has been through a similar experience
To be given written information about the important aspects of your care
To be given information (written, diagrams, drawings) about aspects of managing your illness and side effects at home
To be given explanations of those tests for which you would like explanations
To be adequately informed about the benefits and side effects of treatments before you choose to have them
To be informed about your test results as soon as possible
To be informed about cancer that is under control or diminishing (that is, remission)
To be informed about things you can do to help yourself get well
To be informed about support groups in your area
To have access to professional counselling (e.g., psychologist, social worker, counselor, nurse specialist) if you/family/friends need it
To be treated like a person, not just another case
To be treated in a hospital or clinic that is as physically pleasant as possible
To be given choices about when you go in for tests or treatment
To have one member of hospital staff with whom you can talk to about all aspects of your condition, treatment, and follow-up
Pain
Lack of energy/tiredness
Nausea/vomiting
Feeling unwell
Not sleeping well
Work around the home
Not being able to do the things you used to do
Waiting a long time for clinic appointments
Family or friends to be allowed with you in hospital whenever you want
More fully protected rights to privacy when you’re at the hospital
More choice about which cancer specialist you see
More choice about which hospital you attend
Reassurance by medical staff that the way you feel is normal
Hospital staff to attend promptly to your physical needs
Hospital staff to acknowledge, and show sensitivity to, your feelings and emotional needs
Changes in sexual feelings
Changes in sexual relationships
To be given information about sexual relationships
Talking to other people about the cancer
Changes in other people’s attitudes and behavior towards you
Concerns about your financial situation
Concerns about getting to and from the hospital
56
70
54
73
71
78
78
74
56
64
66
65
74
78
75
57
67
62
73
56
58
55
54
63
76
74
81
82
81
78
78
61
66
70
70
68
70
64
73
54
72
65
64
65
56
68
67
65
71
56
70
67
86
86
67
Health system and
information (15
items)
Physical and daily
living (7 items)
Patient care and
support (8 items)
Sexuality (3 items)
No specific factor
loadings (4 items)
222
CANCER January 1, 2000 / Volume 88 / Number 1
TABLE 3
Cronbach Alpha Coefficients for Each of the Five Factors
Factor
Domain
Cronbach alpha
coefficient
1
2
3
4
5
Psychologic
Health system and information
Physical and daily living
Patient care and support
Issues of sexuality
0.97
0.96
0.90
0.87
0.87
Face and content validity and reading ease
Some preliminary evidence for the face and content
validity of the needs items was confirmed in the results of the preliminary interviews and pilot study with
the separate convenience sample of 200 patients who
had various types of cancer. Patients were asked to
rate the relevance, comprehensiveness, and acceptability of the items and survey format. All patients in
the subsample commented favorably about the comprehensibility of the instrument. When suggestions
were made for additional items by two or more respondents, these were incorporated into the instrument. The response format was well received and
consistently rated as easy to follow and use. A panel of
professional members were also consulted regarding
the face validity of the instrument, and all supported
the premise that the instrument appeared to measure
that which it purported to measure. Overall, the verbal
and written comments of both patients and professionals consistently attested to the face validity and
content validity of the needs items in the modified
instrument.
Tests of reading ease (Flesch-Kincaid formula,
conducted using the computerized Rightwriter32 program) indicated that the survey could be readily comprehended by people with a minimal level of education (fourth to fifth grade education). The average
length of time to complete the survey was 20 minutes.
Internal reliability
Cronbach alpha was used to assess the internal consistency of items comprising each factor. In keeping
with the recommended guidelines,33 an alpha coefficient of 0.7 was the criterion standard of internal consistency that the instrument aimed to achieve. As
shown in Table 3, the reliability coefficients of all 5
factor-based scales were found to be substantial, ranging from 0.87 for the fifth factor to 0.97 for the first
factor.
DISCUSSION
The results of this study provide empiric evidence for
the acceptability, reliability, and validity of a survey
instrument designed to assess the supportive care
needs of patients receiving treatment for cancer. The
instrument meets most of the requirements for needs
assessment instruments, as it measures multiple dimensions of cancer-related needs within a welldefined and recent time frame (1 month), using items
generated from patient input and using a singular
categoric response scale. Moreover, the selfadministered instrument required less than 30 minutes to complete, and was rated as easy to understand
and complete by oncology patient respondents. Quantitative tests of reading ease also confirmed the ease of
readability and low comprehension requirements of
the instrument.
Preliminary evidence was found for the instrument’s ability to fulfill methodologic standards for
achieving an accurate representation of patients’ perceptions of need. Through the factor analytic process,
it was possible to demonstrate statistically the different dimensions of need measured by the scale: psychologic, health information, physical and daily living,
patient care, and issues of sexuality. These dimensions
correspond with past research, which suggests that
psychologic,8,34 daily living,8,35 and information36 –38
issues are important to oncology patients. Four of the
five constructs are similar to those underlying the
CNQ30. Issues of sexuality is a new construct that
evolved following patient consultation during the
early stages of item generation. It may reflect changing
attitudes toward this aspect of patient morbidity.38
Together, these 5 factors accounted for a psychometrically acceptable proportion of the total variance
(64%). Furthermore, evidence for the structural reliability of the Supportive Care Needs Survey was also
found, with Cronbach alpha coefficients exceeding 0.8
in all domains.
Although its development was based on the CNQ,
the Supportive Care Needs Survey differs from its predecessor in a number of ways. First, following consultation with health professionals and people with cancer, a number of CNQ items were either not included
in the Supportive Care Needs Survey or rephrased.
Second, some new items were included (in particular,
those dealing with issues of sexuality). As a result,
despite underlying similarities between the two scales,
the Supportive Care Needs Survey was treated as a
new scale, and exploratory rather than confirmatory
factor analyses were conducted.33
The response format of the survey was found to
display considerable precision in measuring the level
of perceived need. The survey is able to assess whether
an issue has been experienced as a result of having
cancer, the prevalence of met and unmet needs, and
the magnitude of the unmet need within a simple,
Assessing Cancer Patients’ Needs/Bonevski et al.
reliable 5-point response scale. The current method is
conceptually consistent with the recommendation of
the National Cancer Institute’s working group for the
development of methods that would allow measurement of “the relative importance or weight of particular quality of life dimensions for individual patients
and incorporating these weights into the assessment
of the extent to which quality of life is affected by
treatment for cancer.”39 Asking people to indicate the
magnitude of their need (low, moderate, or high) provides us with a direct categoric measure of the relative
importance of one need item against others. The categoric information derived from the instrument also
yields a useful quantitative data set that would facilitate ease of comparisons within and between groups
as well as across time.10
Despite the complexity and wealth of information
that the survey has the potential to yield, the findings
show that oncology patients in this sample found the
instrument easy to complete. The results attested to
the ability of patients to self-administer the survey
successfully without external assistance. Self-administered questionnaires have advantages over other interview or card-sort methods; they are relatively inexpensive to produce, require minimal time and energy
input from staff, and yield quantifiable responses.10,40
The ease of analyzing the data statistically is especially
important to enable ongoing, efficient analyses of the
changing needs of individual patients as a function of
disease, treatment, intervention, or naturalistic factors.
The ability of the survey to assess the magnitude
of needs may be especially important in clinical oncology contexts. By examining the unmet needs most
commonly rated as “moderate” or “high” by different
individuals, the survey could potentially be used as an
assessment tool to alert practitioners of the need to
connect patients with higher level needs to appropriate support resources.41– 44 As group data is accumulated for patients from common diagnostic, stage,
treatment, or sociodemographic groups, it may become possible to predict who will be risk of developing
particular needs. In this way, the survey may be employed in a preventive capacity.
The ease of self-administration of the survey negates the need for expensive and time-consuming personal interviews,10,40 thus increasing the practical feasibility and acceptability of conducting assessments of
patient needs on an ongoing basis as a routine part of
care. More recent trials have employed the survey
using an interactive computer method, further decreasing expense and improving ease of use. The computer application has been found to be acceptable to
patients with cancer in the treatment setting45 and
223
shows promise as a quality assurance or patient education tool. For example, programs that incorporate
patient and provider printouts of health status and
advice are currently under evaluation.45
This article reports the preliminary evaluation of a
new instrument that assesses the needs of people with
cancer. Without doubt, there is room for further refinement of the instrument, including reduction of its
length, continued testing with more diverse populations and young adults, and translation into other
languages. A form of the instrument tailored specifically to people with terminal cancer is also under
development. This instrument was designed to stand
alone as a needs assessment tool. It would add depth
to broader examinations of needs, quality of life, and
other outcomes of interest if used as part of a battery
of instruments. Together with other measures, an indication of the relations among patient outcomes may
be made. However, before it may be applied in such a
manner, it requires significant reductions in length in
order not to overburden patients.
Finally, a number of methodologic issues need to
be delineated. First, a comparison of the data on the
study participants with the 1994 NSW Cancer Registry2
data indicated disparities. These may have been due
to the large sizes of both samples, which may be
magnifying small differences. Further, the NSW sample included patients attending private hospitals,
whereas the current sample consisted of patients visiting public hospitals only. More generally, the patients who completed the survey did not adequately
represent those younger than 30 or older than 85
years, were predominantly white, and did not include
terminally ill people. Second, the data represents the
views of cancer patients in one Australian state and
may therefore further limit wider generalizability of
the results. Third, the response rate (65%) was considerably lower than the consent rate (99%). The issue of
low response rates associated with surveys requiring
the mailing back of instruments by respondents has
plagued similar research.46 –50 Although telephone and
in-clinic surveys have been found to produce higher
response rates,46 the latter tend to be more costly.47
Different strategies for optimizing response rates of
mail-back surveys have been tested, including telephone reminder calls and shortened surveys.48,49 The
study does, however, represent the largest (in terms of
sample size) of its type reported in Australia, incorporating the views of patients undergoing various treatments for numerous types of cancer. Also, the length
of the survey remains an issue that requires attention.
An average of 20 minutes is required to complete the
survey, which consists of 61 needs items. The research
224
CANCER January 1, 2000 / Volume 88 / Number 1
team is currently in the process of developing a short
form of the survey to enhance further its ease of use.
Despite its limitations, the study outlines some of
the pragmatic and methodologic advantages of a generic needs assessment tool for patients with cancer.
The standardized application of the instrument across
treatment centers may potentially yield a valuable
pool of data on patients’ needs. Such data will invariably prove valuable to policymakers and health care
providers who strive toward meeting the needs of
patients living with cancer.
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