Perceived Value of Holistic Needs Assessment in Supporting the Needs of Women With Breast Cancer

Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information.8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures. 9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer.9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information.8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures.9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer.9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information. 8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures.9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer.9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly. The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information.8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures.9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer. 9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information.8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures.9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer.9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information. 8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures.9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer.9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly. The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information.8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures.9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer. 9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information.8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures.9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer.9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information. 8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures.9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer.9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly. The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information.8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures.9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer. 9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information.8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures.9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer.9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.Background Holistic needs assessments (HNAs) were designed to identify and support the physical, psychological, and social impacts of cancer, yet delivery methods vary significantly.The study aimed to explore views of HNAs from the perspectives of healthcare professionals and women with breast cancer, including how the HNA contributed to providing support.A qualitative case study approach was adopted, with 4 hospitals in England. Twenty-four women with cancer and 24 staff were recruited. Data from interviews, observations, and HNA-related documentation were compiled into cases around use of the HNA in each organization. Principles of framework analysis and Normalization Process Theory enabled identification of conclusions.The contribution of HNA to women's experiences of support was complex and dependent on various influences: (1) how the woman's own views and judgments influenced her perceptions of the assessment, (2) how the views of staff delivering the HNA influenced both their own approach to the assessment and patient views, and (3) the organizational context and culture.Apparent superficial implementation of HNAs seemed to facilitate organizational cultures of evidencing the actions of staff and achieving management targets. Women's views toward the HNA appeared paradoxical; most women perceived the HNA to be meaningful "in principle" but reported little benefit of the assessment, and some reported negative outcomes.Holistic needs assessment implementation in clinical settings requires a greater focus on quality over targets, and healthcare professional training should be centered around delivering HNAs in a meaningful way that prioritizes individual patient benefit.Globally, breast cancer affects 1 in 8 women during their lifetime1 and often requires invasive investigations and treatments.2 People with breast cancer have complex physical, psychological, and social needs beyond their cancer diagnosis and throughout treatment.3-6 In the United Kingdom, the National Health Service Long Term Plan emphasizes the need to offer support in line with the national "personalized care" agenda, which focuses on the relationship between healthcare professionals, systems of care, and those requiring care.7 In the context of cancer, this support includes holistic needs assessment (HNA) (also known as personalized care and support planning), end-of-treatment summaries, cancer care review, and health and well-being information. 8 Holistic needs assessments are central to personalized care and involve conducting individualized assessments of people's needs, which translate into care plans and actions to address concerns. Although many forms of HNA exist, Macmillan Cancer Support's electronic HNA (eHNA) is widely adopted in the United Kingdom. The eHNA is an online platform that hosts several HNA tools, accessible by both patients and staff to complete assessments or write care plans.Despite notable benefits of HNAs, such as providing a forum for people to discuss their concerns and empowering self-management, the small evidence base highlighting user perspectives of HNAs suggests challenges with its implementation, day-to-day use and outcomes. For example, management and peer support are essential for the successful setup of HNAs, yet staff resistance to its use was found in many cases.9,10 Also, staff describe challenges in identifying meaningful times and locations to undertake HNAs,9,11,12 as well as how to balance addressing needs identified with workload pressures.9,10,13,14Furthermore, technology can create challenges for healthcare professionals and people with cancer.9,15,16 Some staff lack the confidence to discuss the concerns people raised in their HNAs or perceive items on the HNA to be beyond their conventional nursing job role (eg, advising on financial concerns).10,13 Minimal research has considered experiences of HNAs from the perspective of people with breast cancer, but one study highlighted variable opinions, stating that several participants viewed the assessment's purpose as being for research and having minimal benefit to them.17 Other studies on patients' experiences of HNAs (various cancer types) highlight that people do not consistently disclose concerns during HNAs, for reasons such as fear of particular outcomes (such as social services involvement), perceptions of wasting staff time, misunderstanding the HNA's purpose, or their expectations.10,17,18Overall, little is known about user perspectives of HNAs, and how valuable its contribution is to those undergoing and delivering the assessment. In the United Kingdom, Macmillan Cancer Support's eHNA is widely adopted but lacks research-based evaluation of its use.To investigate the eHNA, principles of Normalization Process Theory (NPT) were used. This theory categorizes and explains key factors that promote or constrain the implementation or integration of innovation into healthcare settings.19 This theory was utilized based on its compatibility with qualitative research, usefulness to explore the barriers and facilitators to implementation of interventions, and the ability to consider the social processes that appear to influence success.19 As a relatively new intervention, the process of embedding eHNA into day-to-day practice aligned with many of NPT's concepts.The research question was: "How does the eHNA contribute to the assessment and support of the holistic needs of women living with or beyond breast cancer?" Primarily, the aims were to understand perceptions of the eHNA and associated care plans, and the contribution of these (if any) to women's experiences of support, from the perspectives of both staff and women with cancer. Furthermore, the study sought to identify facilitators of or barriers to eHNA use.