Title: Trial to evaluate the impact of a Carer Support Needs Assessment Tool (CSNAT) intervention in hospice home care
Funder: Department of Health (England)

Abstract: Background There is increasing emphasis on enabling patients to be cared for and to die in the place of their choice. For most, this is at home, which depends heavily on efforts of family carers who consequently often suffer adverse effects. While government policy and guidelines stress that carer needs should be assessed and addressed, there are no consistent, evidence based procedures for assessing and addressing carers’ support needs in end of life health care practice. To address this gap we have undertaken a programme of research in collaboration with family carers and practitioners to develop a simple, yet comprehensive Carer Support Needs Assessment Tool (CSNAT) intervention (comprising CSNAT assessment, prioritisation and follow up) suitable for use in everyday home care practice. Aims To test whether a formalised, comprehensive procedure for carer support needs assessment, prioritisation and follow up (CSNAT intervention) improves quality of care and carer outcomes in end of life home care, compared to usual care To explore 'active components' of the intervention that may enhance its effectiveness and contextual factors that may help or hinder its effective implementation to inform further implementation To develop an intervention training guide with carers and practitioners to make the CSNAT intervention self sustaining and implementable in end of life home care and distribute the intervention with training guide nation-wide to members of the National Forum for Hospice at Home (NFFH@H) and beyond. Plan of Investigation Stepped Wedge Cluster Randomised Controlled Trial (Phase III trial) with six hospice home care (HHC) services to test the impact of the CSNAT intervention on carers’ perceptions of quality of care and psychological and physical health post bereavement Quantitative investigation of the delivery of the intervention (e.g. timing, duration, frequency, actions recorded on the CSNAT), and exploration of these variables’ relationship with outcomes Qualitative exploration of the ‘active components’ of the CSNAT intervention and challenges in its implementation through audio diaries and focus groups with HHC practitioners and telephone interviews with carers Workshops with HHC practitioners and carers to decide content and format of training guide and dissemination through NFFH@H website Potential Impact The output will be a formalised, evidence-based procedure and training guide for assessment, prioritisation and follow up of carer support needs in end of life care. It has potential to benefit 0.5 million UK carers providing such care by replacing the current informal, incomplete and ad hoc carer needs assessment in end of life health care. The intervention will be sustainable beyond the life of the project as its design has been carer- and practitioner led to ensure applicability and utility for everyday practice, and a user-designed training guide will facilitate implementation in home care practice across the UK. Dissemination will be to National Forum for Hospice at Home members who support some 60,000 carers, and to UK specialist and generalist home care providers in general.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE