needs addressed,¹ inconsistency in domains within the instrument and in items included in similarly named domains, a lack of evidence of sensitivity to change over time, failure to examine reading levels, and failure to address the period after initial treatment for cancer. The authors express their doubt as to whether any one instrument could be developed to address all areas of interest, but recommend that a common set of domain terms be adopted to form the core of needs assessment and that agreement be reached on some items to be placed in the domains. Research also is recommended to address obstacles to the practice of needs assessment, to identify characteristics of effective performance of needs assessment, and to establish the relative importance and significance of identified needs. As with the questions posed above with respect to screening, questions about how best to conduct needs assessment in the presence of comorbidities also require attention.

As described in Chapters 3 and 4, comprehensive illness self-management programs have been found to be effective in improving patient knowledge, skills, and confidence in managing a number of chronic illnesses, such as diabetes, asthma, heart disease, lung disease, stroke, and arthritis. Some of these programs also have been found to be effective in improving health outcomes (Lorig et al., 2001; Bodenheimer et al., 2002; Lorig and Holman, 2003; Chodosh et al., 2005). Yet while particular interventions have been developed and found to be effective in helping cancer patients manage individual symptoms, such as pain and fatigue, comprehensive illness and health management programs similar to those that exist for individuals with other chronic illnesses have not been developed and tested in individuals living with the diagnosis and sequelae of cancer. Research to this end is needed.

Also as discussed in Chapter 4, the various mechanisms used to link patients with services delivered by different health and human service providers (e.g., structured referral arrangements and formal agreements with external providers, case management, collocation and clinical integration of services, patient navigators, use of shared electronic health records) have