Abstract

Background: Family carers play a crucial role in enabling patients to be cared for at home towards the end of life, but often suffer adverse impacts on their psychological and physical health. Government policy and guidelines stress that carers' needs should be assessed and addressed.

Principal objective: To test whether a formalised, comprehensive procedure for carer support needs assessment, prioritisation and follow up (CSNAT intervention) improves quality of care and carer outcomes in end of life home care, compared to usual care.

Design: Stepped wedge cluster trial with six hospice home care services (HHCs): services begin using the intervention in a stepped sequence at 3 month intervals. The first and last service in the sequence are fixed, the start order of the intermediate services is randomised.

Sample: the main carers of patients who received care from participating HHCs.

Data collection: Postal survey of main carers 4-5 months after bereavement to measure psychological and physical wellbeing, level of grief and assessment of quality of care. Collection of data on patients' place of death (home/ inpatient care) from hospice records.

Analysis: comparison between carers who have/ have not had the CSNAT intervention, both between HHCs and within HHCs before/ after they started the intervention.