Factors influencing practitioner adoption of carer-led assessment in palliative homecare: A qualitative study of the use of the Carer Support Needs Assessment Tool (CSNAT)

Abstract

IntroductionInformal caregivers play a pivotal role in supporting patients approaching the end of life. The Carer Support Needs Assessment Tool (CSNAT) is designed to facilitate person-centred assessment and support through a process that is practitioner-facilitated, but carer-led. This study explored practitioners’ experiences of implementing the CSNAT in palliative homecare.MethodsWe conducted qualitative interviews/focus groups with 20 practitioners in one UK hospice homecare service (18 nurses, two healthcare assistants) before and after the implementation of the CSNAT. Thematic analysis of the data was underpinned by framework analysis.ResultsNot all practitioners appreciated that using the CSNAT required a shift towards a more person-centred approach to assessment; consequently they tagged the tool onto their existing practitioner-led practice. Practitioners who did use the CSNAT as intended were able to act as role models and support their colleagues in making this transition. Practitioners’ comments revealed a number of contradictions: 1) Most felt that they ‘already do’ identify carer support needs, but feared using the CSNAT could increase their workload; 2) some worried about introducing the CSNAT ‘too soon’, but recognised that it was ‘too late’ once patients were close to the end of life; 3) whilst practitioners stated ‘they were there for the family as well as the patient’, care provision was overtly centred around patients.ConclusionThis study provides vital insights into barriers and facilitators to implementing the CSNAT as part of a person-centred approach to assessment. The findings identified the training and support required to help practitioners make this transition to this new way of working.

Living environment, social support, and informal caregiving are associated with healthcare seeking behaviour and adherence to medication treatment: A cross‐sectional population study

“…Also, one study of informal caregivers to dementia care receivers showed that informal caregivers in Sweden spend less time in their caregiving when compared with caregivers in another European country, Italy (Chiatti et al, ). Systems for supporting informal caregivers are present in other European countries as well, such as the United Kingdom's Carer's Assessments for adult carers of people who are disabled, ill or elderly and the Carer Support Needs Assessment Tool (Austin, Ewing, & Grande, ). However, caregivers perform a variety of tasks that differ between families, which may complicate the policy‐making and design of a general intervention for this group.…”

Informal Caregivers’ Perceptions of Needs From Hospice Providers: An Integrative Review

“…While the hospice model emphasizes the delicate balance of the IC being both cared for by the hospice providers and a caregiver for the patient, 15 health-care professionals often struggle to recognize and applaud the expertise of the IC. 52,56 The Carers' Alert Thermometer (CAT) 57 and the Carer Support Needs Assessment Tool (CSNAT) 58 are important instruments that can make a significant impact in alleviating deficiencies in ICs' knowledge of services and caregiving skills and help to authenticate the ICs' important role as expert caregivers. Including ICs in interdisciplinary team meetings 34,59 is another possible way to ensure ICs have adequate knowledge of available resources, have their specific needs addressed, and feel like an equal part of the team.…”

Barriers and facilitators to implementing the Carer Support Needs Assessment Tool in a community palliative care setting

“…However, many participants described methods of using the CSNAT that are inconsistent with the recommended approach, such as, using the CSNAT as an 'add-on' to existing nurse-led practice, and not revisiting the CSNAT. Austin et al (2017) also found that the CSNAT was used as an 'add on' to existing practice in their study of its use in palliative home care. This may have been because practitioners did not fully appreciate that CSNAT implementation requires a shift in their carer support approach from being practitioner-led, to practitioner-facilitated but carer-led assessment.…”