Feasibility and effectiveness of the NEST13+ as a screening tool for advanced illness care needs.

Karen G. Scandrett, Eva B. Reitschuler-Cross, Lauren Nelson, J. Alex Sanger, Maia Feigon, Elizabeth Boyd, Chih Hung Chang, Judith A. Paice, Joshua M. Hauser, Alexey Chamkin, Paul Balfour, Alexei Stolbunov, Charles L. Bennett, Linda L. Emanuel

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


BACKGROUND: A comprehensive whole-person approach might improve processes and outcomes of care for patients with cancer. OBJECTIVE: To assess the ability of NEST13+ (Needs of a social nature; Existential concerns; Symptoms; and Therapeutic interaction), a screening and assessment tool, to identify social, emotional, physical, and care-system needs and to improve clinical outcomes for cancer patients in tertiary care. DESIGN, SETTING, PATIENTS: A controlled trial involving 451 patients hospitalized for cancer care at a comprehensive cancer center. INTERVENTION: Patients responded to 13 screening questions regarding possible care needs. When an individual response exceeded threshold levels, additional in-depth questions for the relevant need were asked. For patients in the intervention arm, clinical recommendations for each dimension of need were generated based on a previously developed NEST-response-driven menu, and were reported to the clinical team. MEASUREMENTS: Documented needs, clinician response, patient perception of goals alignment, and overall quality of palliative care. RESULTS: Using the NEST13+ tool in the clinical setting facilitated greater documentation of illness-related needs than routine clinical assessment. Improvement in secondary outcomes was attenuated: changes in the clinician response were modest; changes in outcomes were not significant. CONCLUSION: The NEST13+ tool facilitated identification of a wider range of important needs than traditional evaluation, while care outcomes were not improved. Traditional evaluation may need improvement. Future trials of the NEST13+ should focus on more intensive clinician-directed interventions.

Original languageEnglish
Pages (from-to)161-169
Number of pages9
JournalJournal of palliative medicine
Issue number2
StatePublished - Feb 2010


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