Introduction

The needs of a person facing a serious illness such as cancer are very complex. Maslow argues that human needs arrange themselves in “hierarchies of pre-potency” such that the appearance of one depends upon prior satisfaction of more pre-potent needs. The most pre-potent of Maslow's needs are the physiological (e.g., maintaining homeostasis of oxygen, water). When these are not satisfied, as may be the case in a terminal cancer patient, no other needs are important. As long as those needs are satisfied, a patient or family member may be concerned about higher order needs such as the “safety” needs for predictability and orderliness that underlie the fear of the unknown often faced by newly diagnosed cancer patients. As long as these needs are met, one can hope that providers (as well as family and friends) will satisfy needs for affection and caring. And if these needs are met, one can seek to satisfy “esteem” needs such as the need for respect sought by many health care consumers today. Thus needs change as a patient's condition changes.

What are needs?

As discussed in Langley et al., Kano suggests that needs fall into three categories: expected, desired, and unexpected. And different types of needs have different effects on satisfaction. For instance, most patients and family members expect that they will be given the proper medication. Avoiding medication errors will not improve satisfaction, but making errors could devastate satisfaction.