The impact of the Carer Support Needs Assessment Tool (CSNAT) in community palliative care using a Stepped Wedge Cluster Trial

Evidence suggests that good support for family carers in end of life care can improve carer psychological outcomes. The 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, on family carer outcomes. A stepped wedge cluster trial was used in 3 bases of Silver Chain in WA. 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 carer strain and distress, carer mental and physical health, and carer workload assisting with activities of daily living, at baseline and follow up. Total recruitment was 620. There was 45% attrition mainly due to patient deaths resulting in 322 carers completing the study. The intervention group showed significant reduction in carer strain relative to controls, p=0.018, d=0.348. Priority support needs identified by carers 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 carer strain. Effective implementation of an evidence-informed and carer-led tool represents a necessary step fit for the future towards helping palliative care providers better assess and address carer needs.