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PLoS One. 2015 Apr 7;10(4):e0123012. doi: 10.1371/journal.pone.0123012. eCollection 2015.

The impact of the carer support needs assessment tool (CSNAT) in community palliative care using a stepped wedge cluster trial.

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School of Nursing and Midwifery, Curtin University, Perth, Western Australia, Australia.
School of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, United Kingdom.
School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia; School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
School of Nursing and Centre on Aging, University of Victoria, Victoria, British Columbia, Canada.
Centre for Family Research, University of Cambridge, Cambridge, United Kingdom.


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.

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