Equity in cancer care: mixed methods clinical utility analysis of the Nursing Equity Assessment Tool (NEAT) to identify disadvantage in newly diagnosed cancer patients

Purpose: Individuals who experience complex biomedical factors and poorer social determinants of health (SDoH) have worse cancer outcomes than other people with cancer. This study appraised the clinical utility of the Nursing Equity Assessment Tool (NEAT), designed to facilitate early and systematic identification of such factors to optimise timely referral for support.

Methods: A prospective, mixed-methods case-series study was conducted at a specialist cancer centre. The NEAT comprises 15 items mapping to four biopsychosocial domains. Clinical nurse consultants (CNCs) completed the NEAT with newly diagnosed patients during consultations. Semi-structured interviews exploring clinical utility aspects (appropriateness, acceptability, and practicability) were undertaken with patients at 2 weeks, and CNCs at 12- and 24-week post-completion of the NEAT; then analysed using qualitative content analysis. Participant characteristics were collected via self-report and medical records. Patient-reported outcome measures were completed prior to interviews. Healthcare utilisation data were gathered 12- and 24-week post-completion of the NEAT. Quantitative data were analysed descriptively using measures of association.

Results: Thirty-seven patients and seven CNCs participated. All participants considered the NEAT highly acceptable and appropriate, with potential to improve patient outcomes. Feedback recommended refinements to content and CNC training. Implementation considerations included advocacy for service investment to enable timely receipt of support to address disadvantage.

Conclusions: Patients and CNCs considered this novel point-of-care tool was acceptable, appropriate, and demonstrated promise to help quickly identify and address newly diagnosed cancer patients at risk of complex care needs stemming from medical and non-medical factors.