Holistic Needs Assessment (HNA)

Being diagnosed with cancer and coping with its effects on your life may feel overwhelming. You may have lots of questions or worries. Having an HNA can help make sure you get the support you need for these different concerns.

This may include:

• helping you identify the concerns that are most important to you
• getting information and support to help you manage your concerns – for example, side effects or support with emotional worries
• helping your healthcare team understand what is important to you
• being referred to other services if you need more help or support – for example, physiotherapy, counselling or help with your finances
• helping you to plan ahead.

It can help to think about the concerns you would like to discuss before your HNA.

These are your concerns, so it is up to you what you talk about. Some ideas include your:

• physical symptoms – for example, pain, tiredness, bowel or bladder problems, and weight changes.
• treatment – for example, side effects, fertility, and the risks and benefits of treatment.
• emotions – for example, fear of cancer coming back or the effect of cancer on your relationships.
• sexual well-being – for for example, concerns about intimacy, getting an erection or low sex drive.
• family – for example, how to talk about cancer or worries about genetic risk.
• well-being after treatment – for example, giving up smoking, eating healthily or staying active.
• follow-up appointments – for example, tests you may need and knowing what symptoms to look out for.
• work, money and housing – for example, advice about working during treatment, benefits and financial help.
• practical issues – for example, how to manage housework, and where to get aids and equipment to help you.
• spirituality – for example, your faith or beliefs, and whether your cancer experience has affected these.

For some practical or financial issues, you may be referred to other health or social care services. These will give you further advice and support.

Remember, the concerns we have listed are only a guide. Not everything listed will apply to you. Or you may have concerns that are not listed. We have some suggestions to help you decide what you would like to discuss.

You may find it helpful to make notes of any concerns or questions you have before the discussion.

You may want to think about these questions:

• Are you coping okay?
• Is cancer affecting your relationships with family or friends?
• Are family or friends coping with your diagnosis?
• Would you like to know more about local services, support groups or helplines?
• Do you need advice about your diet, being physically active or stopping smoking?
• Are you confused by any part of your treatment or follow-up care? Is there anything you would like explained?
• Do you need help with finances, work or education?
• Are you worried about the future?
• Do you feel your quality of life could be improved?
• Are you having any symptoms or side effects from the cancer or treatment?
• Do you know what signs and symptoms to look out for and who to contact if you notice any?
• Do you know who to contact if you have any problems? For example, do you have the contact details of your key worker?

Not all these suggestions will be relevant to you. The HNA is about your personal needs and concerns.

During the discussion, you and the person doing your HNA will agree on the best ways to manage your needs and concerns. They may write down what you have agreed in a document called a care plan. This is sometimes called a personalised care and support plan.

It may be written as a letter instead. They may write it during the discussion. Or they may make notes and send it to you afterwards.

Your care plan will record:

• the main concerns you talked about
• suggestions and actions to help you manage your concerns
• services that may be able to support you, and any referrals they make
• what is already being done to help – for example, the services you are already using
• information about who to contact if you need more help
• the details of other health and social care professionals you have agreed to share the information with.

You will be given a copy of your care plan. If you are not offered a copy of your care plan, you can ask for one at any time.

A copy of the care plan may be sent or given to:

• your GP, so they know your concerns and what help is planned
• other members of your healthcare team, to help them plan or improve your care
• specialist support services – for example, a dietitian or counsellor.

The healthcare professional will only share your care plan if you give permission. They will only share as much information as people need to help with your care.

Your care plan will be securely stored with your other health records. You can ask for a review of your care plan, or a new assessment, at any time.

You may be offered an HNA when you are diagnosed, during treatment or after treatment has ended. If you are not offered an HNA, you can ask someone from your healthcare team to arrange one. Your needs may change over time, so you can ask for another HNA at any time.

You may have a separate appointment for the HNA. Or it may happen during one of your other appointments.

You may be sent the checklist of questions to answer online at home before the HNA. Or you may be asked to complete the checklist in the waiting room beforehand. 

The checklist may be on paper or a handheld electronic tablet. If it is done on a tablet, it is called an electronic Holistic Needs Assessment (eHNA). If you need help answering the questions or using the tablet, tell the person doing your HNA.

Some people have their HNA as an informal discussion with someone from their healthcare team. It may not always be called an HNA. They may ask you questions and discuss your answers with you, rather than asking you to fill out a form or complete a checklist.

The HNA usually takes between 30 minutes and 1 hour. Some people need longer. It should take as long as you need to talk about your concerns.

If there are still some things you want to talk about after it has finished, tell the person doing your HNA. They can make another appointment with you.