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Randomized Controlled Trial
. 2017 Sep;7(3):326-334.
doi: 10.1136/bmjspcare-2014-000829. Epub 2015 Dec 30.

Assessing the impact of a Carer Support Needs Assessment Tool (CSNAT) intervention in palliative home care: a stepped wedge cluster trial

Gunn Eli Grande  1 , Lynn Austin  1 , Gail Ewing  2 , Neil O'Leary  3 , Chris Roberts  3
Affiliations
Randomized Controlled Trial

Assessing the impact of a Carer Support Needs Assessment Tool (CSNAT) intervention in palliative home care: a stepped wedge cluster trial

Gunn Eli Grande et al. BMJ Support Palliat Care. 2017 Sep.

Abstract

Objectives: To test the impact on family carers of a Carer Support Needs Assessment Tool (CSNAT) intervention to facilitate carer-led assessment and support during end of life care.

Method: Mixed method, part-randomised, stepped wedge cluster trial with 6 palliative home care services comparing carers receiving the intervention with those receiving standard care. Postal survey with carers 4-5 months postbereavement measured adequacy of end of life support, current mental and physical health (Short Form 12 Health Survey SF-12), level of grief (Texas Revised Inventory of Grief, TRIG) and distress (Distress Thermometer, DT), place of death and carer satisfaction with place of death.

Results: Surveys were sent to 3260 (76%) carers of 4311 deceased patients; 681 (21%) were returned (N=333 control, N=348 intervention). Compared with controls, intervention carers had significantly lower levels of early grief, better psychological and physical health, were more likely to feel the place of death was right, and patients were more likely to die at home. However, differences were small and process measures showed low level of implementation, indicating differences may partially relate to increased awareness of carer issues rather than a direct impact of the intervention.

Conclusions: Carers had better outcomes in the intervention condition, albeit modest. If this can be achieved through low level implementation and awareness raising of carers' needs from implementation activities, substantial impact should be possible if the CSNAT intervention can be fully implemented with a majority of carers. The study illustrates challenges of implementing and testing a complex intervention in real-life practice and of achieving comprehensive carer assessment and support in line with government recommendations.

Keywords: Bereavement; End of life; Family carers; Home care; Needs assessment; Stepped wedge cluster trial.

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Conflict of interest statement

Competing interests: None declared.

References

    1. Gomes B, Higginson IJ. Factors influencing death at home in terminally ill patients with cancer: systematic review. BMJ 2006;332:515–21. 10.1136/bmj.38740.614954.55 - DOI - PMC - PubMed
    1. Grande GE, Ewing G. Death at home unlikely if informal carers prefer otherwise: implications for policy. Palliat Med 2008;22:971–2. 10.1177/0269216308098805 - DOI - PubMed
    1. Aoun SM, Kristjanson LJ, Currow DC, et al. . Caregiving for the terminally ill: at what cost? Palliat Med 2005;19:551–5. 10.1191/0269216305pm1053oa - DOI - PubMed
    1. Schulz R, Beach SR. Caregiving as a risk factor for mortality. The caregiver health effects study. JAMA 1999;282:2215–19. 10.1001/jama.282.23.2215 - DOI - PubMed
    1. Grande GE, Farquhar MC, Barclay SI, et al. . Caregiver bereavement outcome: relationship with hospice at home, satisfaction with care, and home death. J Palliat Care 2004;20:69–77. - PubMed

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