The Needs Assessment for Advanced Cancer Patients (NA-ACP): a measure of the perceived needs of patients with advanced, incurable cancer. a study of validity, reliability and acceptability.

AIMS: To describe the psychometric evaluation of a measure designed to assess the perceived needs of patients with advanced, incurable cancer. METHOD: A questionnaire known as the Needs Assessment for Advanced Cancer Patients (NA-ACP) was developed based on a review of available literature and professional opinion. A sample of 246 patients (consent rate = 59%) completed the NA-ACP, 28 patients completed the acceptability questions, while 41 completed a retest copy of the NA-ACP. The construct validity of the questionnaire was examined via principal components analysis, while reliability was evaluated in terms of the internal consistency of domains and test-retest scores. RESULTS: The principal components analysis revealed seven domains assessing patients' psychological/emotional, medical information/communication, social, symptom, daily living, spiritual and financial needs. The test-retest reliability estimates were within accepted levels, as were all but one of the internal consistency scores. The NA-ACP was highly acceptable for this patient group. CONCLUSION: The NA-ACP is one of the first multi-dimensional instruments specifically designed to assess the needs of patients with advanced, incurable cancer. The present study provides evidence of the NA-ACP's validity, reliability, and acceptability. The NA-ACP has potential applications both as a research tool and within clinical settings.

The intention to hasten death: a survey of attitudes and practices of surgeons in Australia.

OBJECTIVE: To determine attitudes among surgeons in Australia to assisted death, and the proportion of surgeons who have intentionally hastened death with or without an explicit request. DESIGN: Anonymous, cross-sectional, mail-out survey between August and November 1999 PARTICIPANTS: 683 out of 992 eligible general surgeons (68.9% response rate). MAIN OUTCOME MEASURES: Proportion of respondents answering affirmatively to questions about administering excessive doses of medication with an intention to hasten death. RESULTS: 247 respondents (36.2%; 95% CI, 32.6%-39.9%) reported that, for the purpose of relieving a patient's suffering, they have given drugs in doses that they perceived to be greater than those required to relieve symptoms with the intention of hastening death. More than half of these (139 respondents; 20.4% of all respondents; 95% CI, 17.4%-23.6%) reported that they had never received an unambiguous request for a lethal dose of medication. Of all respondents, only 36 (5.3%; 95% CI, 2.9%-6.1%) reported that they had given a bolus lethal injection, or had provided the means to commit suicide, in response to an unambiguous request. CONCLUSIONS: More than a third of surgeons surveyed reported giving drugs with an intention to hasten death, often in the absence of an explicit request. However, in many instances, this may involve the use of an infusion of analgesics or sedatives, and such actions may be difficult to distinguish from accepted palliative care, except on the basis of the doctor's self-reported intention. Legal and moral distinctions based solely on a doctor's intention are problematic.