The Carer Support Needs Assessment Tool (CSNAT) for Use in Palliative and End-of-life Care at Home: A Validation Study

Ewing, Gail; Brundle, Caroline; Payne, Sheila; Grande, Gunn

doi:10.1016/j.jpainsymman.2012.09.008

Cited by 134 publications

(173 citation statements)

References 30 publications

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“…The CSNAT tool was developed and validated by the Universities of Manchester and Cambridge to assess carers' needs in home based end of life care contexts [32,33]. While the tool is designed to capture change over time in carers' needs, in this evaluation, it was not feasible to do so and the questionnaire was issued to current carers on just one occasion in the final period of data collection to achieve a cross sectional picture of their needs at that time point.…”

Section: Carers Support Needs Assessment Tool [Csnat]mentioning

confidence: 99%

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

et al. 2018

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Background: The Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these 'Innovation Centres'. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites. Methods: The study was set within a Realist Evaluation framework and used a longitudinal, mixed methods research design. Data collection over 15 months (2014)(2015)(2016) Qualitative data methods included: focus groups with project team and staff (n = 32 groups with n = 190 participants), and, volunteers (n = 6 groups with n = 32 participants). Quantitative data were analysed using SPPS Vs. 21 and qualitative data was examined via thematic analysis. Results: Comparison of findings across the six sites revealed the impact of their unique configurations on outcomes, compounded by variations in stage and mode of implementation. PPS, PPI and IPOS data revealed disparity in early referral criteria, complicated by contrasting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of specialist home-based clinical interventions was limited. The Macmillan brand engendered patient and carer confidence, bringing added value to existing services. Significant findings included better co-ordination of palliative care through project management and a single referral point and multi-disciplinary teamwork including leadership from consultants in palliative medicine, the role of health care assistants in rapid referral, and volunteer support. Conclusions: Macmillan Specialist Care at Home increases patient choice about place of death and enhances the quality of end of life experience. Clarification of key components is advocated to aid consistency of implementation across different sites and support future evaluative work.

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Section: Carers Support Needs Assessment Tool [Csnat]mentioning

confidence: 99%

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

et al. 2018

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“…Implementation of the ESAS provided improvements in symptom screening, symptom control, and functional assessment [6]. However, there is a group of symptoms which is seldom evaluated in most symptom assessment tools [5], and can be considered as orphan symptoms. At the best of our knowledge, no epidemiological or clinical study exists regarding the prevalence of sweating, hiccup, myoclonus, pruritus, and tenesmus in patients followed by a home palliative care team.…”

Section: Introductionmentioning

confidence: 99%

Orphan symptoms in advanced cancer patients followed at home

Mercadante¹,

Porzio²,

Valle³

et al. 2013

Support Care Cancer

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Orphan symptoms are rarely assessed, particularly at home. The aim of this multicenter prospective study was to assess the prevalence of these symptoms and eventual factors possibly associated in advanced cancer patients at admission of a home care program. A prospective study was performed at three home care programs in Italy. Patients' data were collected, including age, sex, diagnosis, and Karnofsky status. Possible contributing factors were analyzed; preexisting neurological diseases, cerebral metastases, hyperthermia, diabetes, a state of dehydration clinically evident and/or oliguria, possible biochemical parameters when available, data regarding recent chemotherapy, opioids and doses, use of neuroleptics, benzodiazepine or anticonvulsants, corticosteroids, anti-inflammatory, and antibiotics were collected.

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“…The CSNAT domains were developed from focus groups and interviews with 75 bereaved carers 11 and their face and criterion validity tested with 225 current carers. 12 Piloting and feasibility work with practitioners showed perceived benefits of the CSNAT intervention and also some challenges of implementation that informed further CSNAT training and support. 13 14 While promising, the CSNAT intervention required further testing to establish whether it improved carer outcomes.…”

Section: Introductionmentioning

confidence: 99%

Assessing the impact of a Carer Support Needs Assessment Tool (CSNAT) intervention in palliative home care: a stepped wedge cluster trial

Grande¹,

Austin

Ewing

et al. 2015

BMJ Support Palliat Care

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ObjectivesTo test the impact on family carers of a Carer Support Needs Assessment Tool (CSNAT) intervention to facilitate carer-led assessment and support during end of life care.MethodMixed method, part-randomised, stepped wedge cluster trial with 6 palliative home care services comparing carers receiving the intervention with those receiving standard care. Postal survey with carers 4–5 months postbereavement measured adequacy of end of life support, current mental and physical health (Short Form 12 Health Survey SF-12), level of grief (Texas Revised Inventory of Grief, TRIG) and distress (Distress Thermometer, DT), place of death and carer satisfaction with place of death.ResultsSurveys were sent to 3260 (76%) carers of 4311 deceased patients; 681 (21%) were returned (N=333 control, N=348 intervention). Compared with controls, intervention carers had significantly lower levels of early grief, better psychological and physical health, were more likely to feel the place of death was right, and patients were more likely to die at home. However, differences were small and process measures showed low level of implementation, indicating differences may partially relate to increased awareness of carer issues rather than a direct impact of the intervention.ConclusionsCarers had better outcomes in the intervention condition, albeit modest. If this can be achieved through low level implementation and awareness raising of carers’ needs from implementation activities, substantial impact should be possible if the CSNAT intervention can be fully implemented with a majority of carers. The study illustrates challenges of implementing and testing a complex intervention in real-life practice and of achieving comprehensive carer assessment and support in line with government recommendations.

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The Carer Support Needs Assessment Tool (CSNAT) for Use in Palliative and End-of-life Care at Home: A Validation Study

Abstract: The CSNAT is a valid tool for the direct measurement of carers' support needs. It combines comprehensiveness of content with feasibility of administration and has utility both as a research tool and a tool for everyday palliative care practice.

Cited by 134 publications

References 30 publications

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

Orphan symptoms in advanced cancer patients followed at home

Assessing the impact of a Carer Support Needs Assessment Tool (CSNAT) intervention in palliative home care: a stepped wedge cluster trial

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