| الوصف: |
Background: Strategy documents recommend a patient-led approach to identifying and addressing the unmet support needs of patients with long-term conditions. Further recommendations advocate an intervention-model to systematically assess need based around the use of a needs-assessment questionnaire or prompt completed with, or by, the patient, and a patient-HCP conversation. However, despite enthusiasm for these interventions within the qualitative literature, their usefulness in supporting a patient-led approach remains unclear, and there has been limited attention to exploring the case for an alternative person-centred approach to intervention format and delivery. Aim: The aim of this thesis is to critically analyse the nature and usefulness of the Systematic Needs Assessment intervention model as a means to enable a patient-led approach to identifying, expressing and addressing unmet support need, and to make the case for an alternative person-centred approach to intervention format and delivery. In addition, the thesis aims to investigate whether, and how, this alternative approach can support patient-led identification and expression of their unmet support needs in practice through the exploration of an 'exemplar': the Support Needs Approach for Patients (SNAP): consisting of a five-stage approach to delivering person-centred care underpinned by the SNAP Tool. Methods: A mixed methods approach was adopted involving three stages: 1) a thematic synthesis of the relevant qualitative literature; 2) a mixed methods study to assess the face, content and criterion validity of the SNAP Tool; 3) a qualitative study to explore the use of SNAP in clinical practice. Results: The thematic synthesis identified that interventions based around the systematic assessment of patient need tend to support enhanced patient involvement in an HCP-led approach to identifying and addressing support need, rather than a more person-centred patient-led process. Findings also suggested this was a function of intervention characteristics that emphasised the HCP role (e.g. use of instruments designed to measure symptoms). In contrast, elements of a patient-led approach were evident where interventions incorporated features orientated towards person-centred care and support needs (rather than symptoms). Together these limitations exposed a weakness in the evidence base of existing interventions, and lent support for the exploration of an alternative person-centred approach to intervention format and delivery. Consideration of this alternative person-centred approach, via an exemplar intervention (SNAP,) found that SNAP had value in clinical practice and was able to support a person-centred patient-led process. Validity testing of the SNAP Tool found it has good face, content and criterion validity. The qualitative investigation of SNAP further identified that, when delivered as intended, SNAP operationalised person-centred care thereby enabling patient-led identification, expression, and addressing of their unmet support needs. Conclusion: This thesis found that interventions based on a Systematic Needs Assessment intervention model are orientated to supporting enhanced patient involvement in an HCP-led approach to identifying and addressing patient support need, rather than a patient-led approach. In contrast, SNAP provides an alternative person-centred approach to intervention format and delivery that can directly enable patient-led identification, expression, and addressing of their unmet support needs. |
