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.

A person-centred approach to family carer needs assessment and support in dementia community care in Western Australia

“…Consistent with this perspective, most of the CSNAT items relating to enabling the carer to care were either rated less highly or stayed the same when rated for the second time (Figure ). However, items addressing the carers’ health more directly (such as dealing with carers’ feelings and worries, looking after your own health and needing practical help in the home) were rated more highly at the second visit, which could be a reflection of the recognition by carers that their own needs have become more visible and acknowledged now due to the CSNAT, thus feeling that such requests are more legitimised, as reported in previous similar studies (Aoun, Deas, et al., ; Aoun, Grande, et al., ).…”

“…In this study, four of five top carer priorities related to direct support for carers rather than support to directly enable care‐giving. In general, services are geared to providing for clients’/patients’ needs and carers’ needs tend to be overlooked (Aoun, Deas, et al., ; Aoun, Grande, et al., ; Ewing et al., ; Turner et al., ). Consistent with this perspective, most of the CSNAT items relating to enabling the carer to care were either rated less highly or stayed the same when rated for the second time (Figure ).…”

“…The CSNAT's effectiveness and utility have been tested with FCs of patients with cancer at end of life (Aoun, Deas, et al., ; Aoun, Grande, et al., ; Aoun, Toye, et al., ) showing a decrease in carer strain. Results of a trial with FCs of older people discharged home from hospital showed that FCs in the intervention group were significantly more prepared to provide care and reported reduced carer strain and distress compared to FCs in the control group (Toye et al., ).…”

The Influence of Context and Practitioner Attitudes on Implementation of Person‐Centered Assessment and Support for Family Carers Within Palliative Care

“…As such, using the CSNAT intervention involves a change in practice from a practitioner‐led to a carer‐led process of assessment and support, and thus aligns with government policy and national guidelines for carer assessment and support, and recommendations for person‐centered practice (Department of Health [DoH], ; DoH, ; National Institute for Clinical Excellence, ; NHS Scotland, ; National Palliative and End of Life Care Partnership, ). Research on the CSNAT intervention has shown that it improves outcomes for carers (Aoun, Grande et al., ; Grande, Austin, Ewing, O'leary, & Roberts, ) is valued by carers (Aoun, Deas et al., ), and that practitioners feel it has benefits for their practice (Ewing, Austin, & Grande, ).…”

The effectiveness of a nurse‐led intervention to support family caregivers in end‐of‐life care: Study protocol for a cluster randomized controlled trial

“…One of the studies included in the review found effects of an intervention with a needs-assessment (Aoun et al, 2015), the Carer Support Needs Assessment Tool (CSNAT) which is a valid tool to measure the support needs of family caregivers in palliative home care. (Aoun et al, 2015;Ewing, Austin, Diffin, & Grande, 2015). Our intervention is based on this CSNAT.…”