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Effect of the Carer Support Needs Assessment Tool intervention (CSNAT-I) in the Danish specialised palliative care setting: a stepped-wedge cluster randomised controlled trial
  1. Line Lund1,
  2. Lone Ross1,
  3. Morten Aagaard Petersen1,
  4. Annemette Blach2,
  5. Elizabeth Rosted3,
  6. Georg Bollig4,5,
  7. Gitte Irene Juhl6,
  8. Hanne Bollerup Farholt7,
  9. Helen Winther8,
  10. Louise Laursen9,
  11. Marianne Hasse10,
  12. Signe Weensgaard11,
  13. Mai-Britt Guldin12,
  14. Gail Ewing13,
  15. Gunn Grande14 and
  16. Mogens Groenvold1,15
  1. 1Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
  2. 2Hospice Soendergaard, Maaloev, Denmark
  3. 3Department of Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
  4. 4Palliative Care Team, Medical Department Soenderborg/Toender, South Jutland Hospital, Soenderborg, Denmark
  5. 5Medical Research Unit, Institute of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
  6. 6Palliative Care Unit, Department of Oncology and Palliative Care, North Zealand Hospital, Frederikssund, Denmark
  7. 7Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
  8. 8Palliative Care Unit, Odense University Hospital, Odense, Denmark
  9. 9Department of Palliative Care, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
  10. 10Diakonissestiftelsens Hospice, Frederiksberg, Denmark
  11. 11Arresoedal Hospice, Frederiksvaerk, Denmark
  12. 12Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
  13. 13Centre for Family Research, University of Cambridge, Cambridge, UK
  14. 14School of Health Sciences, University of Manchester, Manchester, UK
  15. 15Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Line Lund, Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen DK-2400, Denmark; line.lund.01{at}regionh.dk

Abstract

Background The Carer Support Needs Assessment Tool intervention (CSNAT-I) has been shown to improve end-of-life care support for informal caregivers. This study investigated the impact of the CSNAT-I on caregivers of patients recently enrolled in specialised palliative care (SPC) at home in Denmark.

Methods A stepped-wedge cluster randomised controlled trial with nine clusters (ie, SPC teams). Outcome measures were collected using caregiver questionnaires at baseline (T0) and 2-week (T1) and 4-week (T2) follow-up.

Results A total of 437 caregivers were enrolled (control group, n=255; intervention group, n=182). No intervention effect was found on the primary outcome, caregiver strain at T1 (p=0.1865). However, positive effects were found at T1 and T2 on attention to caregivers’ well-being (p<0.0001), quality of information and communication (p<0.0001), amount of information (T1: p=0.0002; T2: p<0.0001), involvement (T1: p=0.0045; T2: p<0.0001), talking about greatest burdens (p<0.0001) and assistance in managing greatest burdens (p<0.0001). The effect sizes of these differences were medium or large and seemed to increase from T1 to T2. At T1, positive effects were found on distress (p=0.0178) and home care responsibility (p=0.0024). No effect was found on the remaining outcomes.

Conclusion Although no effect was found on caregiver strain, the CSNAT-I showed positive effects on caregiver distress, home care responsibility and key outcomes regarding caregivers’ experience of the interaction with healthcare professionals.

Trial registration number NCT03466580.

  • supportive care
  • home care
  • family management

http://dx.doi.org/10.1136/bmjspcare-2020-002467

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    Footnotes

    • Correction notice This article has been corrected since it is published.

    • Funding The study was funded by the Danish Cancer Society (Grant A8861) and the A.P. Moeller and Chastine Mc-Kinney Moeller Foundation (Grant 11692). The sponsors had no role in the study design, data collection, analysis and interpretation of data, in the writing of the paper, or in the decision to submit the paper for publication.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was carried out in accordance with the 1964 Helsinki Declaration and its later amendments. The study was registered at ClinicalTrials.gov (ID: NCT03466580) and was approved by the Danish Data Protection Board (VD-2018-46). The protocol was presented to the Scientific Ethical Committee system (no. H-16042063) and was found not to require formal approval from the committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Any data sharing requires approval from the Danish Data Protection Board.