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

*Corresponding author for this work

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

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • General Nursing


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