TY - JOUR T1 - 5 What needs to change to better support carers at end of life? a multi-perspective mixed methods study to identify recommendations for change in organisational structures and processes JF - BMJ Supportive & Palliative Care JO - BMJ Support Palliat Care SP - 361 LP - 362 DO - 10.1136/bmjspcare-2018-mariecurie.5 VL - 8 IS - 3 AU - Gail Ewing AU - Gunn Grande Y1 - 2018/09/01 UR - http://spcare.bmj.com/content/8/3/361.2.abstract N2 - Introduction 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 comprehensive assessment/support for carers in EOL practice.MethodsSecondary analysis of qualitative data on implementation in 36 services to identify factors facilitating/hindering implementationExpert consultation (focus groups with 19 lead practitioners/hospice managers) to review Stage–1 findings and develop draft recommendationsWider 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. 10 recommendations identify key structures and processes not normally met by current provision:Consistent identification of carers within the care settingDemographic and contextual data on who the carer is and their situationA method/protocol for assessing carers and responding to assessmentA recording system for carer information (separate from patient data)A process for training staff about carer assessment/supportAvailable time/workload capacity for carer assessment/supportSupport from senior managersRole models/championsPathways for communication about carer assessment/supportProcedures 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 10 recommendations outline necessary building blocks to achieve this change.Funder Hospice UK and CLAHRC Greater Manchester ER -