title: The impact of the carer support needs assessment tool (CSNAT) in community palliative care using a stepped wedge cluster trial.
abstract: Family caregiving towards the end-of-life entails considerable emotional, social, financial and physical costs for caregivers. Evidence suggests that good support can improve caregiver psychological outcomes. The primary aim of this study was to investigate the impact of using the carer support needs assessment tool (CSNAT), as an intervention to identify and address support needs in end of life home care, on family caregiver outcomes. A stepped wedge design was used to trial the CSNAT intervention in three bases of Silver Chain Hospice Care in Western Australia, 2012-14. The intervention consisted of at least two visits from nurses (2-3 weeks apart) to identify, review and address caregivers' needs. The outcome measures for the intervention and control groups were caregiver strain and distress as measured by the Family Appraisal of Caregiving Questionnaire (FACQ-PC), caregiver mental and physical health as measured by SF-12v2, and caregiver workload as measured by extent of caregiver assistance with activities of daily living, at baseline and follow up. Total recruitment was 620. There was 45% attrition for each group between baseline and follow-up mainly due to patient deaths resulting in 322 caregivers completing the study (233 in the intervention group and 89 in the control group). At follow-up, the intervention group showed significant reduction in caregiver strain relative to controls, p=0.018, d=0.348 (95% CI 0.25 to 0.41). Priority support needs identified by caregivers included knowing what to expect in the future, having time for yourself in the day and dealing with your feelings and worries. Despite the challenges at the clinician, organisational and trial levels, the CSNAT intervention led to an improvement in caregiver strain. Effective implementation of an evidence-informed and caregiver-led tool represents a necessary step towards helping palliative care providers better assess and address caregiver needs, ensuring adequate family caregiver support and reduction in caregiver strain.
authors: School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia.
authors: Samar M
authors: SM
authors: Aoun
authors: School of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, United Kingdom.
authors: Gunn
authors: G
authors: Grande
authors: School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia.
authors: Denise
authors: D
authors: Howting
authors: School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia.
authors: Kathleen
authors: K
authors: Deas
authors: School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia.
authors: Chris
authors: C
authors: Toye
authors: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia; School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
authors: Lakkhina
authors: L
authors: Troeung
authors: School of Nursing and Centre on Aging, University of Victoria, Victoria, British Columbia, Canada.
authors: Kelli
authors: K
authors: Stajduhar
authors: Centre for Family Research, University of Cambridge, Cambridge, United Kingdom.
authors: Gail
authors: G
authors: Ewing
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data*; D003376:Counseling; D018479:Early Intervention, Educational; D005260:Female; D006301:Health Services Needs and Demand; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data*; D010166:Palliative Care; D010865:Pilot Projects; D012111:Residence Characteristics; D012944:Social Support; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014904:Western Australia; D055815:Young Adult