Background Carers play a vital role in supporting patients at end of life (EOL). EOL care policy promotes comprehensive person-centred assessment/support for carers, but without a clear implementation strategy this will only remain an aspiration.

Aim To develop recommendations for organisational structures/processes required for implementation of comprehensive person-centred assessment/support for carers in EOL practice.

Methods 1) Secondary analysis of qualitative data on implementation in 36 services to identify factors facilitating/hindering implementation. 2) Expert consultation (focus groups with 19 lead practitioners/hospice managers) to review Stage1 findings and develop draft recommendations. 3) Wider stakeholder consultation – two professional workshops (23 participants: hospice, hospital, community, policy and academics), online survey (62 participants) and two carer workshops (nine participants) to finalise recommendations.

Results Comprehensive, person-centred carer assessment/support requires whole-systems change; a cultural shift at practitioner and organisational level. Ten recommendations identify key structures and processes not normally met by current provision:

• Consistent identification of carers within the care setting

• Demographic and contextual data on who the carer is and their situation

• A method/protocol for assessing carers and responding to assessment

• A recording system for carer information (separate from patient data)

• A process for training staff about carer assessment/support

• Available time/workload capacity for carer assessment/support

• Support from senior managers

• Role models/champions

• Pathways for communication about carer assessment/support

• Procedures for monitoring/auditing processes and outcomes of carer assessment/support.

Conclusions Comprehensive, person-centred carer support requires radical change, at different organisational levels. Carers’ fit within service provision also urgently needs clarification. Our ten recommendations outline necessary building blocks to achieve this change.