What is The CSNAT Intervention?
The CSNAT intervention has been developed, validated and implemented in practice as part of a programme of research on carer assessment and support led by Professor Gunn Grande at the University of Manchester and Dr Gail Ewing at the University of Cambridge. The intervention comprises two components: (1) an evidence based, comprehensive tool for assessment of the support needs of family members/friends who are in a caregiving role for someone with a life limiting illness and (2) a defined five stage person-centred process. Together, as The CSNAT Approach, they enable a holistic and systematic process of assessment and support that is carer-led and tailored to their individual needs. The CSNAT Approach differs from existing practice where identification of carers’ needs which tends to be informal and unstructured, and the process is led by the health care professional rather than by the carer.
Component (1), the tool itself, is a direct measure of support needs encompassing support to enable carers to care for the patient as co-workers (e.g. knowing what to expect in the future, understanding the illness, managing symptoms) and support for themselves as clients (e.g. their own physical health, dealing with their feelings and worries). The tool uses a question format to ask whether the carer needs more support in the 14 areas (referred to as domains) and uses a simple system to enable carers to indicate how much more support, if any, they need.
For use in practice, the CSNAT is integrated into a five stage process of assessment and support (Component 2). The five stages enable carers to identify and prioritise domains where they need more support, have a conversation with a practitioner to express their individual support needs, then agree any further supportive input (shared action plan) which is subsequently reviewed. As the support required within a given domain varies between individuals, carers’ self-identification of required support during conversations with practitioners is crucial.
This is a further stage of the programme of work of the CSNAT research team which is being supported by CLAHRC GM. The researchers are examining the feasibility of using The (CSNAT) Approach in a hospital setting to support carers at discharge.
Why is it important?
The majority of people wish to die in their usual place of residence. Discharge of patients from hospital at end-of-life relies heavily on family carers’ ability and willingness to help care for the patient. However, carers often feel uninvolved and unsupported in the discharge process, and palliative care patients are often re-admitted to hospital following discharge because of a breakdown in carer support at home.
The CSNAT has been shown to help carers, but so far it has been used mainly within hospice care and community settings. The researchers wish to examine the feasibility of using The CSNAT Approach to support carers before and after hospital discharge. This will enable them to identify factors that support successful implementation and also implementation challenges in this setting.
A hospital palliative care team, and a community nursing team will use the CSNAT Approach to assess and support carers before and after hospital discharge. Training and support will be provided to these teams to help them implement the CSNAT Approach as part of their routine practice. Qualitative methods will be used to explore the teams’ experiences of using the intervention in practice.