Publications

Please select any of the links below to view our publications on the development and validation of the CSNAT and its use in practice to support family carers.







Background: Family carers are crucial in making home care possible at end of life. Carer factors contribute to difficulties in achieving timely hospital discharge for patients and to potentially avoidable readmissions.

Aim: To investigate how carers’ support needs are identified prior to patient discharge from acute care towards end of life (EOL) and suitability of using the evidence based Carer Support Needs Assessment Tool (CSNAT) in discharge planning.

Method: Qualitative design: focus groups (FGs) with practitioners supporting patient discharge from three acute hospital trusts in England. 39 participants: hospital specialist practitioners from palliative care and complex discharge plus community Macmillan nurses and district nurses. FGs explored discharge processes, challenges in supporting carers and potential value of the CSNAT. Thematic framework analysis.

Results: Palliative care discharges were complex: from different wards across hospitals involving many practitioners. Although carers were at times involved in discharge discussions, the focus was on patients’ needs. Practitioners viewed the CSNAT as potentially valuable in the context of challenges faced in supporting carers. Practitioners regularly had to manage carers’ (often unrealistic) expectations of their caregiving role at home and levels of support available, but without any guiding framework for identifying their needs. The simple question format of the CSNAT was valued, allowing issues discussed to come from the carer’s perspective, rather than from the organisation. It was seen to permit anticipatory work with carers who had not yet thought through the extent of the caring role at home. Practitioners found carers not always able to express worries, but identified the CSNAT as enabling them to articulate concerns.

Conclusion: The CSNAT shows potential to enhance support for carers at hospital discharge and play a role in preventing readmissions towards the end of life.

Funder: Marie Curie Cancer Care.


Introduction: Successful hospital discharge and prevention of readmission often depend on carers’ ability to support patients.

Aim: To investigate how carers are supported during patient discharge from acute care towards end of life (EOL) and suitability of using a Carer Support Needs Assessment Tool (CSNAT) to improve this support.

Methods: Qualitative design: focus groups (FGs) with 40 practitioners supporting patient discharge from three English acute hospital trusts; interviews with 22 carers of patients discharged. 14 practitioners and 5 carers joined two final workshops. FGs/interviews/workshops explored current discharge processes and potential value of using CSNAT. Thematic framework analysis was conducted.

Results: Both practitioners and carers viewed CSNAT as highly relevant in supporting carers at discharge. Discharge processes were heavily focussed on patients: carers were consulted but about patients’ needs; there was no systematic approach to supporting carers. CSNAT was identified as a means of facilitating much needed EOL conversations which often were absent, enabling carers to articulate concerns, and managing carers’ expectations of their caregiving role at EOL and support available (or not) in the community. However, palliative care discharges were complex: from many different wards involving different practitioners. No single professional group was identified as best placed to support carers. Feasibility issues included skills, confidence and time for carer assessment and support. A two stage process using CSNAT earlier in hospital admission, then as a carer-held  record to manage transition to home were seen as ways forward.

Conclusion: CSNAT shows good potential to enhance carer support at hospital discharge and play a role in preventing readmissions towards EOL.

References

1 Ewing G, Brundle C, Payne S, Grande G. The Carer Support Needs Assessment Tool (CSNAT) for use in palliative and end-of-life care at home: A validation study. J Pain Symptom Manage 2013;46:395–405

2 Ewing G, Grande GE. Development of a Carer Support Needs Assessment Tool (CSNAT) for end of life care practice at home: a qualitative study. Palliat Med 2013;27:244–256


 

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