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Who cares for the carers at hospital discharge at the end of life? A qualitative study of current practice in discharge planning and the potential value of using The Carer Support Needs Assessment Tool (CSNAT) Approach.

Published version
Peer-reviewed

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Authors

Austin, Lynn 
Jones, Debra 

Abstract

BACKGROUND: Carer factors prevent patients achieving timely and appropriate hospital discharge. There is a lack of research into interventions to support carers at hospital discharge. AIM: To explore whether and how family carers are currently supported during patient discharge at end of life; to assess perceived benefits, acceptability and feasibility of using The Carer Support Needs Assessment Tool (CSNAT) Approach in the hospital setting to support carers. DESIGN: Qualitative. SETTING/PARTICIPANTS: Three National Health Service Trusts in England: focus groups with 40 hospital and community-based practitioners and 22 carer interviews about experiences of carer support during hospital discharge and views of The CSNAT Approach. Two workshops brought together 14 practitioners and five carers to discuss implementation issues. Framework analysis was conducted. RESULTS: Current barriers to supporting carers at hospital discharge were an organisational focus on patients' needs, what practitioners perceived as carers' often 'unrealistic expectations' of end-of-life caregiving at home and lack of awareness of patients' end-of-life situation. The CSNAT Approach was viewed as enabling carer support and addressing difficulties of discussing the realities of supporting someone at home towards end of life. Implementation in hospital required organisational considerations of practitioner workload and training. To enhance carer support, a two-stage process of assessment and support (hospital with community follow-up) was suggested using the CSNAT as a carer-held record to manage the transition. CONCLUSION: This study identifies a novel intervention, which expands the focus of discharge planning to include assessment of carers' support needs at transition, potentially preventing breakdown of care at home and patient readmissions to hospital.

Description

Keywords

Carers, discharge planning, needs assessment, palliative care, person-centred care, qualitative research, Adult, Caregivers, England, Female, Focus Groups, Humans, Interviews as Topic, Male, Middle Aged, Needs Assessment, Patient Discharge, Qualitative Research, Social Support, Surveys and Questionnaires, Terminally Ill, Young Adult

Journal Title

Palliat Med

Conference Name

Journal ISSN

0269-2163
1477-030X

Volume Title

32

Publisher

SAGE Publications
Sponsorship
Marie Curie Cancer Care (via University of Manchester) (C9257/A17071)