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).

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.

Aims: 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 NHS 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, and carers’ often “unrealistic expectations” of EOL 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 CSNAT as a carer-held record to manage the transition.
Conclusions: 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.