title: A process evaluation of systematic risk and needs assessment for caregivers in specialised palliative care.
abstract: BACKGROUND
  Caregiving is strenuous and it may be associated with adverse psychological outcomes. During the palliative care trajectory, there are unique opportunities for providing support and preventing poor bereavement outcome. However, the tasks of palliative care staff in relation to caregivers are often unclear in the daily practice. Assessment is recommended to establish risk and needs and standards for caregiver support are available. Still, the feasibility of applying these standards among caregivers in everyday clinical practice has not been tested so far.
  
  
  METHODS
  This study tested the feasibility of an intervention based on key elements of the "Bereavement support standards for specialist palliative care services" in a Danish specialised palliative home care team. We followed the UK Medical Research Council's guidelines for the process evaluation of complex interventions. The intervention consisted of: 1. Systematic risk and needs assessment for caregivers at care entry; 2. Interdisciplinary conference to prepare a support plan; 3. Targeted support; 4. The establishment of an electronic medical record for caregivers to document targeted support. Outcomes included the reach, fidelity and acceptability of the intervention as well as the assessment of contextual factors.
  
  
  RESULTS
  The intervention reached 76 of 164 caregivers (46%). The interdisciplinary risk assessment and documentation of a support plan was conducted in 57 (75%) of the enrolled caregivers. Finally, a separate medical record was established according to the intervention blueprint for 62% of caregivers receiving targeted support. After managing initial challenges, palliative care staff reported that the intervention was useful and acceptable.
  
  
  CONCLUSIONS
  The intervention proved feasible and useful. Still, we identified barriers to the implementation which should be taken into consideration when planning implementation of a systematic risk and needs assessment and in the establishment of medical records for caregivers.
authors.affiliation: Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark. kia.toft@oncology.au.dk.
authors.forename: Kia Toft
authors.identifier: http://orcid.org/0000-0002-4697-8114
authors.initials: KT
authors.lastname: Thomsen
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Denmark.|The Palliative Team, Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark.
authors.forename: Mai-Britt
authors.initials: MB
authors.lastname: Guldin
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Denmark.
authors.forename: Mette Kjærgaard
authors.initials: MK
authors.lastname: Nielsen
authors.affiliation: Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark.
authors.forename: Chaitali Laura
authors.initials: CL
authors.lastname: Ollars
authors.affiliation: Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark.
authors.forename: Anders Bonde
authors.initials: AB
authors.lastname: Jensen
mesh_terms: D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D003718:Denmark; D006801:Humans; D020380:Needs Assessment; D010166:Palliative Care / Q000592:standards*; D000070659:Patient Comfort; D017064:Process Assessment, Health Care / Q000379:methods*; D011446:Prospective Studies; D036301:Qualitative Research; D018570:Risk Assessment / Q000379:methods*; D013315:Stress, Psychological / Q000209:etiology; D000078329:Workforce
keywords: Bereavement risk assessment; Caregiver support; Family caregiver; Needs assessment; Palliative care