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

J Palliat Med. 2010 Feb;13(2):161-9. doi: 10.1089/jpm.2009.0170.


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.

MeSH terms

  • Aged
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Mass Screening / instrumentation*
  • Middle Aged
  • Needs Assessment*
  • Neoplasms / physiopathology
  • Neoplasms / therapy
  • Oncology Service, Hospital
  • Severity of Illness Index*
  • Surveys and Questionnaires / standards*