title: The role of the Carer Support Needs Assessment Tool in palliative home care: A qualitative study of practitioners' perspectives of its impact and mechanisms of action.
abstract: BACKGROUND
  The importance of supporting family carers is well recognised in healthcare policy. The Carer Support Needs Assessment Tool is an evidence-based, comprehensive measure of carer support needs to facilitate carer support in palliative home care.
  
  
  OBJECTIVE
  To examine practitioner perspectives of the role of the Carer Support Needs Assessment Tool intervention in palliative home care to identify its impact and mechanisms of action.
  
  
  METHODS
  Qualitative - practitioner accounts of implementation (interviews, focus groups, reflective audio diaries) plus researcher field notes.
  
  
  METHODS
  A total of 29 staff members from two hospice home-care services - contrasting geographical locations, different service sizes and staff composition. A thematic analysis was conducted.
  
  
  RESULTS
  Existing approaches to identification of carer needs were informal and unstructured. Practitioners expressed some concerns, pre-implementation, about negative impacts of the Carer Support Needs Assessment Tool on carers and expectations raised about support available. In contrast, post-implementation, the Carer Support Needs Assessment Tool provided positive impacts when used as part of a carer-led assessment and support process: it made support needs visible, legitimised support for carers and opened up different conversations with carers. The mechanisms of action that enabled the Carer Support Needs Assessment Tool to make a difference were creating space for the separate needs of carers, providing an opportunity for carers to express support needs and responding to carers' self-defined priorities.
  
  
  CONCLUSIONS
  The Carer Support Needs Assessment Tool delivered benefits through a change in practice to an identifiable, separate assessment process for carers, facilitated by practitioners but carer-led. Used routinely with all carers, the Carer Support Needs Assessment Tool has the potential to normalise carer assessment and support, facilitate delivery of carer-identified support and enable effective targeting of resources.
authors.affiliation: Centre for Family Research, University of Cambridge, Cambridge, UK ge200@cam.ac.uk.
authors.forename: Gail
authors.initials: G
authors.lastname: Ewing
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
authors.forename: Lynn
authors.initials: L
authors.lastname: Austin
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
authors.forename: Gunn
authors.initials: G
authors.lastname: Grande
mesh_terms: D017028:Caregivers / Q000523:psychology*; D017144:Focus Groups; D006699:Home Care Services / Q000592:standards*; D017051:Hospice Care / Q000379:methods / Q000523:psychology* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D020380:Needs Assessment; D010166:Palliative Care / Q000379:methods / Q000523:psychology* / Q000592:standards; D010348:Patient Care Team; D036301:Qualitative Research; D012944:Social Support
keywords: Carers; evidence-based practice; expressed need; needs assessment; palliative care; qualitative research