A drive for structure: A longitudinal qualitative study of the implementation of the Carer Support Needs Assessment Tool (CSNAT) intervention during hospital discharge at end of life
Open accessAbstract
Background: Informal carers are essential in enabling discharge home from hospital at end of life and supporting palliative patients at home, but are often ill-prepared for the role. Carers’ support needs are rarely considered at discharge. If carers are less able to cope with home care, patient care may suffer and readmission may become more likely. Aim: To investigate the implementation of an evidence-based Carer Support Needs Assessment Tool (CSNAT) intervention to support carers during hospital discharge at end of life. Design: Longitudinal qualitative study with thematic analysis. Setting/participants: One National Health Service Trust in England: 12 hospital practitioners, one hospital administrator and four community practitioners. We provided training in CSNAT intervention use and implementation. Practitioners delivered the intervention for 6 months. Data collection was conducted in three phases: (1) pre-implementation interviews exploring understandings, anticipated benefits and challenges of the intervention; (2) observations of team meetings and review of intervention procedures and (3) follow-up interviews exploring experiences of working with the intervention. Results: Despite efforts from practitioners, implementation was challenging. Three main themes captured facilitators and barriers to implementation: (1) structure and focus within carer support; (2) the ‘right’ people to implement the intervention and (3) practical implementation challenges. Conclusions: Structure and focus may facilitate implementation, but the dominance of outcomes measurement and performance metrics in health systems may powerfully frame perceptions of the intervention and implementation decisions. There is uncertainty over who is best-placed or responsible for supporting carers around hospital discharge, and challenges in connecting with carers prior to discharge.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Using thematic analysis in psychology
Braun, V., & Clarke, V. (2006) · Qualitative Research in Psychology · doi:10.1191/1478088706qp063oa · Cited by 194,414 · see citing works
Developing and evaluating complex interventions: the new Medical Research Council guidance
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008) · BMJ · doi:10.1136/bmj.a1655 · Cited by 10,995 · see citing works
Strategies for ensuring trustworthiness in qualitative research projects
Shenton, A. K. (2004) · Education for Information · doi:10.3233/efi-2004-22201 · Cited by 9,748 · see citing works
Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8775 · Cited by 2,887 · see citing works
Developing and evaluating complex interventions: the new Medical Research Council guidance
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2012.09.010 · Cited by 1,658 · see citing works
Heterogeneity and changes in preferences for dying at home: a systematic review
Gomes, B., Calanzani, N., Gysels, M., HALL, S. L., & Higginson, I. J. (2013) · BMC Palliative Care · doi:10.1186/1472-684x-12-7 · Cited by 1,034 · see citing works
Factors influencing death at home in terminally ill patients with cancer: systematic review
Gomes, B., & Higginson, I. J. (2006) · BMJ · doi:10.1136/bmj.38740.614954.55 · Cited by 976 · see citing works
Kingston, A., Robinson, L. A., Booth, H., Knapp, M. R. J., Jagger, C., & for the MODEM project (2017) · Age and Ageing · doi:10.1093/ageing/afx201 · Cited by 837 · see citing works
Bone, A. E., Gomes, B., Etkind, S. N., Verne, J., Murtagh, F. E., Evans, C., & Higginson, I. J. (2017) · Palliative Medicine · doi:10.1177/0269216317734435 · Cited by 393 · see citing works
Ewing, G., & Grande, G. (2012) · Palliative Medicine · doi:10.1177/0269216312440607 · Cited by 218 · see citing works
Self-citationEwing, G., Brundle, C., Payne, S. A., & Grande, G. (2012) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2012.09.008 · Cited by 169 · see citing works
Self-citationRowland, C., Hanratty, B., Pilling, M. A., van den Berg, B., & Grande, G. (2017) · Palliative Medicine · doi:10.1177/0269216317690479 · Cited by 139 · see citing works
Self-citationAoun, S. M., Grande, G., Howting, D. A., Deas, K., Toye, C. M., Troeung, L., Stajduhar, K., & Ewing, G. (2015) · PLoS ONE · doi:10.1371/journal.pone.0123012 · Cited by 130 · see citing works
Self-citationAlonso‐Babarro, A., Bruera, E. D., Varela-Cerdeira, M., Boya-Cristia, M. J., Madero, R., Vigil, I. T., de Castro, J., & González-Barón, M. (2011) · Journal of Clinical Oncology · doi:10.1200/jco.2010.31.6752 · Cited by 126 · see citing works
Grande, G., Rowland, C., van den Berg, B., & Hanratty, B. (2018) · Palliative Medicine · doi:10.1177/0269216318793286 · Cited by 95 · see citing works
Self-citationGrande, G., Austin, L., Ewing, G., O’Leary, N., & Roberts, C. (2015) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2014-000829 · Cited by 90 · see citing works
Self-citationAteş, G., Ebenau, A. F., Busa, C., Csikós, Á., Hasselaar, J. G. J., Jaspers, B., Menten, J. J., Payne, S. A., Beek, K. V., Varey, S., et al. (2018) · BMC Palliative Care · doi:10.1186/s12904-018-0291-7 · Cited by 82 · see citing works
The experience of family caregivers caring for a terminal patient at home: A research review
Martín‐Martín, J., Olano‐Lizarraga, M., & Saracíbar‐Razquin, M. (2016) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2016.09.010 · Cited by 75 · see citing works
Developing a person-centred approach to carer assessment and support
Ewing, G., Austin, L., Diffin, J., & Grande, G. (2015) · British Journal of Community Nursing · doi:10.12968/bjcn.2015.20.12.580 · Cited by 72 · see citing works
Self-citationJack, B., Mitchell, T. K., Cope, L. C., & O'Brien, M. R. (2016) · Journal of Advanced Nursing · doi:10.1111/jan.12983 · Cited by 56 · see citing works
Toye, C. M., Parsons, R. W., Slatyer, S., Aoun, S. M., Moorin, R. E., Osseiran‐Moisson, R., & Hill, K. (2016) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2016.09.012 · Cited by 56 · see citing works
Ewing, G., Austin, L., Jones, D. J., & Grande, G. (2018) · Palliative Medicine · doi:10.1177/0269216318756259 · Cited by 48 · see citing works
Self-citationDiffin, J., Ewing, G., Harvey, G., & Grande, G. (2018) · BMC Palliative Care · doi:10.1186/s12904-018-0382-5 · Cited by 36 · see citing works
Self-citationDiffin, J., Ewing, G., Harvey, G., & Grande, G. (2018) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12323 · Cited by 19 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Shin, H. D., Hamovitch, E., Gatov, E., MacKinnon, M., Samawi, L., Boateng, R., Thorpe, K. E., & Barwick, M. (2025) · PLOS Digital Health · doi:10.1371/journal.pdig.0000418 · Cited by 40 · see citing works
“As such, we found four studies in this review that used the NASSS framework for non-digital innovations [45,58,63,76], demonstrating the framework’s adaptability and utility.”
Gray, T. F., Revette, A. C., Nava‐Coulter, B., Gould, K., Close, S. D., Sullivan, L. M., Flynn, K. E., Katsetos, K. A., Cutler, C. S., Ho, V. T., et al. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09445-2 · Cited by 6 · see citing works
Goodrich, J., Firth, A. M., Gaczkowska, I., Harding, R., Murtagh, F. E., & Evans, C. (2025) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2025.105193 · Cited by 6 · see citing works
Kisch, A. M., Bergkvist, K., Adalsteinsdóttir, S., Wendt, C., Alvariza, A., & Winterling, J. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-022-07306-w · Cited by 6 · see citing works
Antunes, B., Barclay, S. I. G., Kuhn, I., Eagar, K., Bausewein, C., Murtagh, F. E., Etkind, S. N., Bowers, B., Dixon, S., Lovick, R., et al. (2026) · BMC Palliative Care · doi:10.1186/s12904-026-01997-2 · Cited by 5 · see citing works
Implementation Strategies for Quality Improvement in Palliative Care: A Scoping Review
Dai, Y., Daveson, B. A., Gan, L., Ding, J., Chen, Y., & Johnson, C. E. (2024) · Health Expectations · doi:10.1111/hex.14151 · Cited by 4 · see citing works
Ghizzardi, G., Maga, G., Brera, A. S., Milani, I., Falbo, S., Petralito, M., Terzoni, S., Lusignani, M., & Caruso, R. (2024) · Journal of Palliative Medicine · doi:10.1089/jpm.2024.0097 · Cited by 2 · see citing works
A short form tool for clinical assessment of caregivers’ reaction
Grov, E. K., Wilde‐Larsson, B., Kjøs, B. Ø., & Hov, R. (2025) · BMC Palliative Care · doi:10.1186/s12904-025-01844-w · Cited by 1 · see citing works
Dadich, A., Gliniecka, M., Cull, M., & Womsley, K. (2023) · BMC Palliative Care · doi:10.1186/s12904-023-01279-1 · Cited by 1 · see citing works
Goodrich, J., Firth, A. M., Gaczkowska, I., Harding, R., Murtagh, F. E., & Evans, C. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5155435 · Cited by 1 · see citing works
Antunes, B., Barclay, S. I. G., Kuhn, I. L., Eagar, K., Bausewein, C., Murtagh, F. E., Etkind, S. N., Bowers, B., Dixon, S., Lovick, R., et al. (2025) · Research Square · doi:10.21203/rs.3.rs-7358185/v1 · Cited by 1 · see citing works
Brooks, J. M., Hall, A., Higgerson, J., Long, H. A., Urwin, S., & Rowland, C. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-085922
Self-citationMarston, C., L'etang, M., Philip, J. A. M., Morgan, D. D., Edbrooke, L., Chang, S., & Agar, M. R. (2025) · Palliative & Supportive Care · doi:10.1017/s1478951525100710
Anker‐Hansen, C., Østnes, S.-H., Torgersen, K., Karlsen, E., Helgesen, A. K., & Grøndahl, V. A. (2025) · BMC Nursing · doi:10.1186/s12912-025-03960-7
Dadich, A., Gliniecka, M., Cull, M., & Womsley, K. (2023) · Figshare · doi:10.6084/m9.figshare.24417561
- Authors
- Hall, A., Ewing, G., Rowland, C., & Grande, G.
- Affiliations
- Salford Royal NHS Foundation Trust (GB)
- University of Cambridge (GB)
- Corresponding author
- Hall, Alex
- Venue
- Palliative Medicine
- Publisher
- SAGE Publications
- Published
- 2020-06-03
- Volume
- 34
- Issue
- 8
- Pages
- 1088-1096
- ISSN
- 0269-2163 (ISSN-L)
- 1477-030X
- PMC
- PMC7388143
- OpenAlex
- W3029986036
- Cited by
- 15
- References
- 24
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 3 · 2023: 2 · 2022: 1
- FWCI
- 0.56
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Palliative Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by)
- Funders
- National Institute for Health Research
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- informal caregivers, Carer Support Needs Assessment Tool, hospital discharge, end of life, palliative care, implementation barriers and facilitators, home care
- MeSH terms
- Death, England, Hospitals, Humans, Patient Discharge, State Medicine, Caregivers, Needs Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
