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

“… study testing a tool that is practical for clinical use. Nurses frequently are in a position of needing to quickly assess caregiver needs and to coordinate the multiple disciplines and services required to support family caregivers so that they can best support the patients in their care.”

Ewing G, Brundle C, Payne S, Grande G; National Association for Hospice at Home

http://www.medscape.com/viewarticle/814707?src=wnl_edit_tpal&uac=185065HV

The Carer Support Needs Assessment Tool

Family caregivers need support in caring for patients at the end of life, yet brief tools to assess their support needs are not available. To address this gap, Ewing and colleagues developed a brief Carer Support Needs Assessment Tool (CSNAT), suitable for everyday practice.

OBJECTIVES: To assess face, content, and criterion validity of the CSNAT and measure sensitivity to change over time.

METHODS: Participants in the study were 225 adult caregivers of patients from 6 Hospice Home Care services in the United Kingdom. Caregivers were surveyed at baseline and at 4-week follow-up using the CSNAT and tools measuring distress, strain, positive appraisals, preparedness, global health, help with activities of daily living, and patients’ symptom levels. Qualitative feedback on CSNAT was sought through 10 caregiver interviews and professional and caregiver advisory group input.

The investigators found that the CSNAT has good validity and covered caregiver support needs. CSNAT scores showed positive correlations with strain and distress, negative correlations with preparedness for caregiving and global health, and sensitivity to change over time. The CSNAT is shared as a valid tool for palliative care practice.

Viewpoint

Changes in healthcare delivery are having a profound impact on healthcare systems and clinicians but an equally significant effect on family caregivers. Family members are the true “24/7” care providers amidst complex treatments and multiple medications. They often must care for older patients with multiple chronic illnesses. The role of family caregivers is even more vital in palliative care, where symptom management and emotional burdens may be even more intense.

A key role for nurses in supporting family caregivers had been assessment of needs to guide education and supportive interventions. This study tested a tool for future use in research and practice. The CSNAT includes several dimensions of understanding the patient’s illness, symptom management and giving medications, personal care such as bathing and toileting, knowing whom to contact, and support with equipment. Psychosocial aspects such as talking with the patient about the illness and what to expect in the future were also included.

A strength of the tool is that it also assesses elements of self-care, such as financial or work issues, practical help at home, and respite from caregiving. The instrument contains only 14 items and has been shown to be feasible and valid and to create minimal burden. Ewing and colleagues have appropriately identified unanswered questions and future directions. They suggest that to fully integrate the tool in practice, further research should address how and when the CSNAT should optimally be introduced and how to implement the CSNAT findings into the plan of care.

This is an excellent study testing a tool that is practical for clinical use. Nurses frequently are in a position of needing to quickly assess caregiver needs and to coordinate the multiple disciplines and services required to support family caregivers so that they can best support the patients in their care.

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(3):395-405 (ISSN: 1873-6513)

http://www.medscape.com/medline/abstract/23245452

Ewing G; Brundle C; Payne S; Grande G;

CONTEXT: Family carers need to be supported in their central role of caring for patients at the end of life, but brief practical tools to assess their support needs have been missing. To address this gap, we developed a brief evidence-based Carer Support Needs Assessment Tool (CSNAT) suitable for everyday practice.

OBJECTIVES: To assess face, content, and criterion validity of the CSNAT and measure sensitivity to change over time.

METHODS: Participants were 225 adult carers of patients from six U.K. Hospice Home Care services. Carers were surveyed at baseline and at four-week follow-up using self-completed questionnaires, including CSNAT, standard measures (distress, strain, positive appraisals, preparedness, and global health), help provided with activities of daily living, and patients’ symptom levels. Qualitative feedback on CSNAT was sought through 10 pilot carer interviews and professional and carer advisory group input.

RESULTS: The CSNAT has good face, content, and criterion validity. CSNAT domains comprehensively covered carer support needs. CSNAT scores showed clear and consistent positive correlations with strain and distress and negative correlations with preparedness for caregiving and global health. There also were clear correlations with help with activities of daily living and some relationships with positive appraisals and symptom burden. The CSNAT’s sensitivity to change in relevant domains was similar to other measures.

CONCLUSION: 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.

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