title: Addressing the needs of caregivers of cancer patients in general practice: a complex intervention.
abstract: BACKGROUND
  This study aimed to develop an innovation to assist general practitioners (GPs) in Australia to proactively address the needs of caregivers of people with cancer.
  
  
  METHODS
  Six GPs were video recorded each consulting six actor-patients in their respective practices. All cases depicted caregivers of people with cancer. The patients were instructed to complete a Needs Assessment Tool for Caregivers (NAT-C), before the consultation. Actor-patients were instructed to present the NAT-C to three of the six GPs they consulted, selected at random. Two assessors independently reviewed each consultation performance using the Leicester Assessment Package (LAP). The practitioners and actor-patients focused on the value of the NAT-C and how it could be deployed to best effect in a subsequent 'stimulated recall session'.
  
  
  RESULTS
  Thirty-four consultations were successfully recorded. The mean duration of consultations was 13 min. 47 sec. (range 6 min. 3 sec. to 22 min. 51 sec.). GPs differed in core competencies as measured by the LAP (P<0.001), range 37-92%. However, they demonstrated no significant differences in performance (LAP scores) analysed by scenario (P = 0.99). The 'generalised estimating equation' (GEE) model identified an improved LAP score in consultations in which the NAT-C was used (average of 3.3 points; 95% CI: -3.99, 10.6), after controlling for the different GPs and scenarios, but this improvement was not statistically significant (P = 0.37). The participants felt that the NAT-C was beneficial and suggested how it could be further refined.
  
  
  CONCLUSIONS
  If this innovation had been formally tested in a randomised trial without assessing its impact on the consultation there might have been significant difficulties with administering the intervention in practice.
authors.affiliation: Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Western Australia, WA 6845, Australia. m.jiwa@curtin.edu.au
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Mitchell
authors.forename: David
authors.initials: D
authors.lastname: Sibbrit
authors.forename: Afaf
authors.initials: A
authors.lastname: Girgis
authors.forename: Letitia
authors.initials: L
authors.lastname: Burridge
mesh_terms: D000328:Adult; D001315:Australia; D017028:Caregivers; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000458:organization & administration*; D009369:Neoplasms; D010817:Physician-Patient Relations; D010821:Physicians, Family