Table 4 Results of the interview to assess tool´s face validity, applicability, relevance and acceptability among health care personnel

Face validity (n = 27)

1) The tool measures unmet needs of patients with heart failure and their caregivers

23 (85%)

4 (15%)

“to properly assess caregiver needs, the caregiver should be present in the interview”, “the tool is more useful for younger patients as they may have a higher disease burden than older patients”

Applicability (n = 27)

1) The tool is easy to use

17 (63%)

7 (26%)

3 (11%)

“very complex and detailed”, “difficult to differentiate between Some/Potential and Significant in the level of concern”

2) Different professional groups can fill out the tool

23 (85%)

4 (15%)

2. a) Which professional group should fill out the tool?

Palliative care staff (nurses and physicians) replied: physicians and nurses;

General practitioners and social workers replied: physicians, nurses, social worker; Psychologists replied: physicians and nurses

Cardiology staff (nurses and physicians) replied: mainly nurses;

3) The tool instructions are was easy to understand

27 (100%)

4) The tool instructions are helpful

25 (93%)

2 (7%)

"instructions are useful but too long"

5) A special training is necessary to fill out the tool

16 (59%)

1 (4%)

10 (37%)

"for certain items, explanations are required", "maybe not a training, but an introduction to explain the purpose of the tool to increase motivation", "online training is an option", "training is required for non-specialized nurses", "the first and the last page of the tool have a lot of information that can be explained during a training session"

6) There are some difficulties in using the tool

18 (67%)

4 (15%)

5 (18%)

"many questions involve several aspects", "regarding the field action taken, there are situations you cannot act", "patients’ needs sufficient linguistic and cognitive skills", "an entire clinic needs to be willing to use the tool", " time consuming, especially with patients who have a lot to say", "needs a lot of time and empathy", "if filled out by nurses, they are not allowed to refer patients"

Relevance (n = 27)

2) Some questions are irrelevant and can be left out

1 (4%)

3 (11%)

23 (85%)

"3.6: it is not clear what the question intends to assess", "2.7: not very useful", "2.7: formulated very complicated and too long", “section 3" and "4" are repeated and should be merged”, “questions 2.5 and 2.3 have a similar content”, "2.5: not sure what it should capture"

Acceptability (n = 27)

1) Filling out the tool does not take too much time and can be integrated into daily routine clinical practice

13 (48%)

5 (19%)

9 (33%)

"it is too long and takes too much time", "it requires training or a very complete introduction", "not possible in the cardiology consultation, maybe the palliative care has time"

a) When should the tool be applied?

"early, in the first or second consultation", "not too early, it needs a basis of trust", "not too early, when the patient has dealt with the disease", "if the patient becomes more symptomatic or consultations become more frequent"

b) How often should the tool be applied?

"when something has change", "at rehospitalisation", "regularly, every 6 months", "during annual controls", "in patients who are deteriorating faster", "after regular intervals of 6 -12 months ask those questions where there were needs", "ask in every consultation if something has changed"

2) I feel uncomfortable asking some of the questions

4 (15%)

9 (33%)

14 (52%)

"questions 2.3, 2.5, 2.6, 3.6 and 4.2 are about topics hard to discuss (emotional, spiritual concerns, family or financial issues)", "patient may not like to talk about financial issues (question 2.6)", "2.5 and 2.6 need to be asked carefully (spiritual concerns or financial issues)", "2.3 is very personal (psychological issues)"