RESEARCH ARTICLE Open Access A process evaluation of systematic risk and needs assessment for caregivers in specialised palliative care Kia Toft Thomsen 1* , Mai-Britt Guldin 2,3 , Mette Kjærgaard Nielsen 2 , Chaitali Laura Ollars 1 and Anders Bonde Jensen 1 Abstract Background: Caregiving is strenuous and it may be associated with adverse psychological outcomes. During the palliative care trajectory, there are unique opportunities for providing support and preventing poor bereavement outcome. However, the tasks of palliative care staff in relation to caregivers are often unclear in the daily practice. Assessment is recommended to establish risk and needs and standards for caregiver support are available. Still, the feasibility of applying these standards among caregivers in everyday clinical practice has not been tested so far. Methods: This study tested the feasibility of an intervention based on key elements of the “Bereavement support standards for specialist palliative care services” in a Danish specialised palliative home care team. We followed the UK Medical Research Council’s guidelines for the process evaluation of complex interventions. The intervention consisted of: 1. Systematic risk and needs assessment for caregivers at care entry; 2. Interdisciplinary conference to prepare a support plan; 3. Targeted support; 4. The establishment of an electronic medical record for caregivers to document targeted support. Outcomes included the reach, fidelity and acceptability of the intervention as well as the assessment of contextual factors. Results: The intervention reached 76 of 164 caregivers (46%). The interdisciplinary risk assessment and documentation of a support plan was conducted in 57 (75%) of the enrolled caregivers. Finally, a separate medical record was established according to the intervention blueprint for 62% of caregivers receiving targeted support. After managing initial challenges, palliative care staff reported that the intervention was useful and acceptable. Conclusion: The intervention proved feasible and useful. Still, we identified barriers to the implementation which should be taken into consideration when planning implementation of a systematic risk and needs assessment and in the establishment of medical records for caregivers. Keywords: Family caregiver, Palliative care, Caregiver support, Needs assessment, Bereavement risk assessment Background Caregivers constitute an important source of support for patients in palliative care. However, caregiving is often strenuous and may be associated with adverse psycho- logical outcomes [1–4]. Thus, caregivers may need support to fulfill their task. Several studies have tested interventions aiming at reducing the distress associated with caregiving [5–9]. Still, support should be delivered according to the individual caregiver’ s need [10, 11]. During the palliative care trajectory, there are unique opportunities for assessing the need for support and risk of poor bereavement outcomes among caregivers. Al- though support to caregivers during illness and after the patient’ s death is defined as part of palliative care [12], it is often unclear which procedures and routines should be adopted by palliative care staff in daily clinical practice [13]. A recent survey by the EAPC Bereavement Care Taskforce showed that only a quarter of 302 European palliative care services used a formal risk assessment tool, and that 197 (66%) services stated that their bereavement * Correspondence: kia.toft@oncology.au.dk 1 Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C 8000, Denmark Full list of author information is available at the end of the article © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Thomsen et al. BMC Palliative Care (2017) 16:23 DOI 10.1186/s12904-017-0196-x