Background/rationale
Healthcare disparities in cancer outcomes largely stem from unaddressed social determinants of health, with socially disadvantaged patients demonstrating significantly poorer outcomes. The Nurse Equity Assessment Tool (NEAT) is a nurse-led intervention developed to systematically identify patients with complex care needs at point-of-care, enabling targeted resource allocation and person-centred care planning aligned with value-based healthcare principles. The NEAT is action-oriented; each item aligns with evidence and maps to support services for needs identified through application at point-of-care.
Methods
The NEAT was designed by, with, and for cancer nurses through rigorous multi-stage stakeholder review with 100 senior cancer nurses, followed by pilot testing. Clinical utility testing involved 7 clinical nurse consultants and 37 newly diagnosed cancer patients. Participatory action research engaged culturally and linguistically diverse (CALD) consumers to refine cultural relevance and acceptability. Education materials were co-designed with nurses, and acceptability testing conducted in regional settings.
Impact on practice
Clinical nurse consultants reported excellent integration into existing workflows, with minimal additional time required for completion. Newly diagnosed patients found the NEAT relevant, acceptable, and appropriate. CALD consumers endorsed relevance, while advocating inclusion of healthcare navigation items. Co-designed education materials supported nurse confidence in using the NEAT. The NEAT may streamline information sharing within and across treating teams, improving timeliness to care. Integration of NEAT data into administrative datasets has potential to optimise resource allocation to those who need it most, supporting value-based care principles.
Discussion
The NEAT represents an opportunity to operationalise equity-centred care. Key lessons include the importance of co-design processes, culturally responsive adaptation, and integrating equity assessments into routine workflows. Future directions include utility testing among prioritised groups, like Indigenous populations, and an implementation trial to demonstrate clinical benefit. Systematic attention to social determinants through nurse-led assessment meaningfully contributes to optimising care delivery and improving outcomes for all patients.