Our programme of work began in 2007. We realised that it was important to support carers during caregiving to preserve their health and well-being, but it was not well known which aspects of support were most important to carers. There were also no tools suitable for assessing carers’ support needs in a systematic way within everyday practice.
Development of the Carer Support Needs Assessment Tool
We carried out two studies where we asked carers themselves to tell us what the important aspects of support were for them when caring for someone with a palliative illness. In the first we worked with 75 bereaved carers who could reflect back on their whole experience of caregiving and that enabled us to identify a set of 14 key areas of support needs (what we refer to as domains). These were then evaluated in the second study where we surveyed 225 current carers about their support needs and other aspects of their caregiving experience. The outcome of these two studies was the Carer Support Needs Assessment Tool (CSNAT) as a comprehensive, evidence based assessment tool for carers.
Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: A qualitative study. Palliative Medicine. 2013; 27(3):244-256.
The Carer Support Needs Assessment Tool (CSNAT) for Use in Palliative and End-of-life Care at Home: A Validation Study. Journal of Pain and Symptom Management. 2013;46(3):395-405.
Defining ‘The CSNAT Approach’
Through further work with services using the tool in practice, it became apparent that to benefit carers, the CSNAT needed to be used within a person-centred approach which enables carers to consider, express and prioritise their support needs. Dr Lynn Austin helped to develop what is now known as The CSNAT Approach; a five stage process of assessment and support for carers.
Developing a person-centred approach to carer assessment and support. British Journal of Community Nursing. 2015;20(12); 580-584.
The role of the Carer Support Needs Assessment Tool (CSNAT) in palliative home care: qualitative study of practitioners’ perspectives of its impact and mechanisms of action. Palliative Medicine. 2015;30(4):392-400.
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). PLoS ONE 2017;12(6): e0179287. https://doi.org/10.1371/journal.pone.0179287
Benefits to carers of using ‘The CSNAT Approach’
Two trials have investigated the benefits to carers of using The CSNAT Approach: an Australian trial found that it led to reduced strain among carers during caregiving, whilst a UK trial found it reduced grief and improved psychological and physical health post-bereavement. Carers furthermore reported that using the CSNAT helped them express their needs and gain support, validation, reassurance and empowerment.
Supporting family caregivers to identify their own needs in end of life care: Qualitative findings from a stepped wedge cluster trial. Palliative Medicine. 2015;29(6):508-517.
Assessing the impact of a Carer Support Needs Assessment Tool (CSNAT) intervention in palliative home care: a stepped wedge cluster trial.
Understanding implementation in practice
The next step was to understand how The CSNAT Approach could be successfully implemented into routine practice across a range of palliative and end-of-life care services. We did this in two ways: through our research studies and providing CSNAT Approach training workshops. We conducted a national implementation study with 36 services across the UK, and a smaller case study project with Ayrshire Hospice on their implementation experiences. We have also provided training and support sessions to a large numbers of services. The results from these projects and feedback from the training sessions have since informed the development of our training and implementation toolkit for organisations seeking to implement The CSNAT Approach.