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Introduction We revisited the global concept of subjective quality of life (QoL) as assessed by the WHOQOL-BREF to investigate whether it could be elaborated into a conceptually more comprehensive instrument with good psychometric properties. Responding to a growing need for shorter QoL measures with broader social, spiritual and environmental contents, facets from WHOQOL international modules were examined for potential integration into the new WHOQOL-Combi. Method Adults over 65 years, diagnosed with one or more chronic diseases (n = 2833), completed 41 WHOQOL items during the CLASSIC survey; each item represented a WHOQOL facet. This pool of specific QoL facets contained 24 from the WHOQOL-BREF (excluding general items), and 17 from recent international WHOQOL short-form modules, selected for their generic properties. Rasch modelling reduced the final item pool when assessing the WHOQOL-Combi’s conceptual structure. Comparisons are made with the WHOQOL-BREF. Results Modelling confirmed the tenability of a 36-item solution scored as a five-domain profile, comprised of 24 WHOQOL-BREF facets and 12 new facets from modules. Social and psychological domains were strengthened by three facets, spiritual QoL by five, and physical QoL by one. The WHOQOL-Combi showed sound model fit, excellent internal consistency (α = .95), and scores discriminated between socio-demographic categories. Concurrent validity with the EQ-5D-5L was confirmed for physical and psychological domains. Performance was similar to the WHOQOL-BREF. Conclusion The WHOQOL-Combi offers a contemporary, comprehensive, integrated, multi-dimensional subjective QoL instrument with enhanced evaluations of social, spiritual, psychological and physical QoL. Acceptable to older people, future research should evaluate younger age groups and other cultures.

ObjectiveFamily caregivers play an essential role in end-of-life care but suffer considerable impact on their own health. A better understanding of main factors related to carers’ health is important to inform interventions. The purpose of the study was to test for the first time the potential impact of a comprehensive set of observable variables on carer health during end-of-life caregiving within a population-based carer sample.DesignNational retrospective, cross-sectional, 4-month post-bereavement postal census survey of family carers of people who died from cancer.Setting and participantsRelatives who registered a death from cancer during a 2-week period in England were identified from death certificates by the Office of National Statistics; response rate was 1504/5271 (28.5%).Outcome measuresCarers’ mental health was measured through General Health Questionnaire (GHQ)-12; general health was measured through EuroQoL EQ-Visual Analogue Scale (EQ-5D VAS).MethodsSurvey questions to measure potential variables associated with carer health were based on past research and covered patients’ symptoms and functioning; caregiving activities and hours; informal and formal help received; work hours, other caregiving, volunteering; changes to work, income and expenditure; sleep and relaxation; and demographic variables. Bivariate analyses and ordinary least square regression were performed to investigate these variables’ relationship with outcomes.ResultsPatients’ psychological symptoms and functioning, caregiving hours, female gender and self-sought formal help related to worse mental health. General practitioner and social care input and relaxation related to better mental health. Patients’ psychological symptoms, caregiving hours and female gender were associated with worse general health, and older age, employment and relaxation were associated with better general health.ConclusionsImprovements in carers’ health overall may be made by focusing on potential impacts of patients’ psychological symptoms on carers, facilitating respite and relaxation, and paying particular attention to factors affecting female carers.

The NHS routinely evaluates the quality of life of patients receiving hip or knee replacement surgery using patient-reported outcome measures (PROMs), but some hospital completion rates are only 30%, restricting data usefulness. Statistics limit insights into how and why data are missing, so qualitative methods were used to explore this issue. Observation periods preceded semistructured interviews with 34 preoperative patients attending an orthopedic outpatient clinic. Interview themes covered: completion time/timing, orientation, setting, measures, and practicalities. Triangulated against observations, pragmatic barriers, and facilitators were considered. Refined themes included completion conditions, patient support, and national delivery. Simple improvements (e.g., quiet zone) could improve completion rates and reducing missing data. Reorganizing preoperative leaflets and their systematic distribution via standardized procedures could reassure patients, enhancing PROMs acceptance, while reducing inquiries and subsequent staff burden. Findings have implications for interpreting national statistics. They indicate that further debate about mandating preoperative PROMs is due.

Background Informal caregivers represent the foundation of the palliative care workforce and are the main providers of end of life care. Financial pressures are among the most serious concerns for many carers and the financial burden of end of life caregiving can be substantial. Methods The aim of this critical debate paper was to review and critique some of the key evidence on the financial costs of informal caregiving and describe how these costs represent an equity issue in palliative care. Results The financial costs of informal caregiving at the end of life can be significant and include carer time costs, out of pocket costs and employment related costs. Financial burden is associated with a range of negative outcomes for both patient and carer. Evidence suggests that the financial costs of caring are not distributed equitably. Sources of inequity are reflective of those influencing access to specialist palliative care and include diagnosis (cancer vs non-cancer), socio-economic status, gender, cultural and ethnic identity, and employment status. Effects of intersectionality and the cumulative effect of multiple risk factors are also a consideration. Conclusions Various groups of informal end of life carers are systematically disadvantaged financially. Addressing these, and other, determinants of end of life care is central to a public health approach to palliative care that fully recognises the value of carers. Further research exploring these areas of inequity in more depth and gaining a more detailed understanding of what influences financial burden is required to take the next steps towards meeting this aspiration. We will address the conclusions and recommendations we have made in this paper through the work of our recently established European Association of Palliative Care (EAPC) Taskforce on the financial costs of family caregiving.

Background: Carers’ end-of-life caregiving greatly benefits society but little is known about the monetary value of this care. Aim: Within an end-of-life cancer setting: (1) to assess the feasibility and content validity of a post-bereavement measure of hours of care; and (2) to obtain a monetary value of this informal care and identify variation in this value among sub-groups. Design and setting: A census based cross-sectional survey of all cancer deaths from a 2-week period in England collected detailed data on caregiving activity (10 caregiving tasks and the time spent on each). We descriptively analyse the information carers provided in ‘other’ tasks to inform content validity. We assigned a monetary value of caregiving via the proxy good method and examined variation in the value via regression analysis. Results: The majority of carers (89.9%) were able to complete the detailed questions about hours and tasks. Only 153 carers reported engaging in ‘other’ tasks. The monetary value of caregiving at end-of-life was £948.86 per week with social and emotional support and symptom management tasks representing the largest proportion of this monetary valuation. Time of recall did not substantially relate to variation in the monetary value, whereas there was a stronger association for the relationship between the carer and recipient, carer gender and recipient daily living restrictions. Conclusion: The monetary valuation we produce for carers’ work is substantial, for example the weekly UK Carers’ Allowance only amounts to 7% of our estimated value of £948.86 per week. Our research provides further information on subgroup variation, and a valid carer time instrument and method to inform economic evaluation and policy.

ObjectivesMotor neurone disease (MND) is a progressive, life-limiting illness. Caregiving impacts greatly on family carers with few supportive interventions for carers. We report Stages 1 and 2 of a study to: (1) explore experiences of MND caregiving and use carer-identified support needs to determine suitability and acceptability of the Carer Support Needs Assessment Tool (CSNAT), (2) adapt the CSNAT as necessary for comprehensive assessment and support of MND carers, prior to (Stage 3) feasibility testing.DesignQualitative: focus groups, interviews and carer workshops.SettingThree UK MND specialist centres serving a wide range of areas.ParticipantsStage 1: 33 carers, 11 from each site: 19 current carers, 14 bereaved. Stage 2: 19 carer advisors: 10 bereaved, 9 current carers. Majority were spouses/partners ranging in age from under 45 years to over 75 years. Duration of caring: 4 months to 12.5 years.ResultsCarers described challenges of a disease that was terminal from the outset, of ‘chasing’ progressive deterioration, trying to balance normality and patient independence against growing dependence, and intensive involvement in caregiving. Carers had extensive support needs which could be mapped to existing CSNAT domains: both ‘enabling’ domains which identify carers’ needs as co-workers as well as carers’ ‘direct’ needs as clients in relation to their own health and well-being. Only one aspect of their caregiving experience went beyond existing domains: a new domain on support needs with relationship changes was identified to tailor the CSNAT better to MND carers.ConclusionsCarers of people with MND found the adapted CSNAT to be an appropriate and relevant tool for assessment of their support needs. The revised version has potential for assessment of carers in other longer-term caring contexts. A further paper will report the Stage 3 study on feasibility of using the adapted CSNAT in routine practice.

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.

Background Family carers play a vital role in supporting people with Motor Neurone Disease (MND) but face substantial physical and mental demands in doing so. Timely support from healthcare professionals is crucial to enable carers to fulfil their caregiving role and to look after their own wellbeing. The Carer Support Needs Assessment Tool (CSNAT) intervention is an evidence-based approach for person-centred assessment and support. This project aimed to: (i) adapt the CSNAT intervention to the context of MND care; (ii) test implementation of the adapted CSNAT-MND intervention within specialist MND services. Methods Stage 1: focus groups and interviews with 14 bereaved and 19 current carers to explore support needs (met and unmet) and supportive inputs at key stages of the patient’s illness. Stage 2: workshops with 24 practitioners and 19 carer advisers to adapt the content of CSNAT intervention and its delivery within MND care. Stage 3: implementation of CSNAT-MND in three specialist MND services; interviews with practitioners and carers exploring their experiences of the intervention. Results Content of CSNAT-MND included an additional domain on support with relationships. Intervention implementation adapted to (1) legitimise assessment of carer support needs as part of routine care in MND by practitioners, (2) delivery of a stand-alone introduction stage of the CSNAT-MND intervention and (3) provide a dedicated assessment and planning conversation at a subsequent contact. This basic model was then suited to fit the working practices of three different MND services. We will present challenges of tailoring and implementing the CSNAT-MND intervention in real life practice. Conclusion Implementation of the CSNAT-MND requires the establishment of a clear protocol defined at service level. This project provides insights into how carers of people with MND want to be assessed and supported, how this process can be delivered, and the feasibility of implementing the CSNAT-MND in practice.

Background The Carer Support Needs Assessment Tool (CSNAT) intervention identifies and addresses the support needs of family carers. This carer-centred approach involves a change in practice from a practitioner to carer-led process of assessment and support. Training is needed to help practitioners transition to this new way of working, and implementation support is required at an organisational level (Austin, Ewing & Grande, 2017; Diffin, Ewing, Harvey & Grande, 2018; Diffin, Ewing, Harvey & Grande, 2018). An online training and implementation toolkit was therefore developed to provide accessible and structured guidance on how to implement and embed the CSNAT intervention. Aim To explore the feasibility and acceptability of delivering implementation training through an online format. Methods The online toolkit has two learning components: (1) Individual: knowledge for practitioners to use the intervention, (2) Organisational: to assist a project team to plan, pilot and sustain implementation. Five UK palliative care services participated; 2–4 practitioners from each completed the toolkit. Online survey administered upon completion of each learning component for feedback on content, followed by telephone interview. Results Fifteen practitioners completed ‘Learning component 1’ survey, 14 completed ‘Learning component 2’ survey, and 13 were interviewed. Feedback on content was positive. The most enjoyable aspects were the practical examples and the key steps to implementation being clearly detailed. The suitability of online learning was influenced by resource availability, the nature/size of the team, and individual learning styles. Variation in location of completion (work/home or both) was partly explained by availability of IT equipment, space, and time within the organisation. Whilst the majority of participants saw the value of online learning, some preferred face-to-face delivery, and so blended learning to include group discussions was deemed appropriate. Conclusions Whilst online learning is welcomed by practitioners, organisations need to give it the same priority as attendance at face-to-face workshops and ensure sufficient resources are available to enable completion. Blended learning may help accommodate different learning preferences. Funder NIHR CLARHC Greater Manchester.

Background Carers play a vital role in supporting patients at end-of-life (EOL) enabling care at home and preventing hospital (re)admission. EOL care policy promotes comprehensive person-centred assessment and support for carers, but without a clear implementation strategy this remains an aspiration. Aims (1) To develop recommendations for organisational structures and processes required for implementation of comprehensive person-centred assessment and support for carers in EOL practice. (2) To identify the structures and processes currently in place to achieve assessment and support for carers of patients receiving EOL care through UK hospice organisations. Methods (1) Ten recommendations were constructed from the findings of secondary analysis of existing research data and extensive expert and stakeholder consultation. (2) All hospices providing adult services within Hospice UK’s membership (n=200) were eligible to participate in a cross-sectional survey between March and June 2018. Results An organisational survey was developed to assess hospice provision against the 10 national recommendations published by Hospice UK (2018) for organisational change needed to deliver current EOL care policy guidance for comprehensive, person-centred assessment and support for family carers (Ewing & Grande, 2018). 115 (58%) hospices responded to the survey. 37% used a formal carer assessment process; 13% reported a specific action plan for carers. Other recommendations met at a higher rate, included recording demographic carer data (95%) and consistent identification of carers within hospices (87%). Less frequently met were monitoring and auditing of carer support (31%), and consistent storage of carer-specific data (18%). Results for each recommendation will be presented. Discussion Most organisations met recommendations for structures and processes to achieve assessment and support for carers, although comprehensiveness of provision varied, and formal assessment provision occurred at a low rate. Conclusion Some recommendations are well established in UK hospices, though particular areas for improvement include the use of person-centred processes specific to carers: formal assessment, action plans, recording processes and monitoring systems.

Family carers face substantial demands when supporting people with Motor Neurone Disease (MND) (Aoun et al., 2013). Timely support from healthcare professionals is crucial to enable carers to fulfil their caregiving role and to look after their own wellbeing. The CSNAT intervention is an evidence-based approach for person-centred assessment and support. This project aimed to adapt the CSNAT intervention to the context of MND care, and test its implementation within specialist MND services. Stage 1 involved interviews and focus groups with carers (n=33) to explore carers’ support needs at key stages of the patient’s illness; stage 2 involved workshops with carers (n=19) and practitioners (n=22) to adapt the content of CSNAT intervention and its delivery within MND care. Stage 3 involved implementation of the adapted CSNAT-MND in three specialist MND services, and interviews with practitioners (n=6) and carers (n=6) exploring their experiences of the intervention. Content of CSNAT-MND included an additional domain on support with relationships. Intervention implementation adapted to (1) legitimise assessment of carer support needs as part of routine care in MND by practitioners, (2) deliver of a stand-alone introduction stage of the CSNAT-MND intervention and (3) provide a dedicated assessment and planning conversation at a subsequent contact. This basic model was then suited to fit the working practices of three different MND services. This project provides insights into how carers of people with MND want to be assessed and supported, how this process can be delivered, and the feasibility of implementing the CSNAT-MND in routine practice.

Context The goal of advance care planning (ACP) is to help ensure that the care people receive during periods of serious illness is consistent with their preferences and values. There is a lack of clear understanding about how patients and their informal carers feel ACP discussions should be implemented. Objectives The objective of this study was to synthesize literature reviews pertaining to patients' and informal carers' perspectives on ACP discussions. Methods This is a systematic review of reviews. Results We identified 55 literature reviews published between 2007 and 2018. ACP discussions were facilitated by a diverse range of formats and tools, all of which were acceptable to patients and carers. Patients and carers preferred health professionals to initiate discussions, with the relationships they had with the professionals being particularly important. There were mixed feelings about the best timing, with many people preferring to defer discussions until they perceived them to be clinically relevant. ACP was felt to bring benefits including a greater sense of peace and less worry, but it could also be disruptive and distressing. Patients and carers perceived many benefits from ACP discussions, but these may differ from the dominant narratives about ACP in health policy and may move away from the narratives of RCTs and standardization in research and practice. Conclusion Researchers and clinicians may need to adjust their approaches as current practices are not aligned enough with patients' and carers' preferences. Future research may need to test implementation strategies of ACP interventions to elucidate how benefits from standardization and flexibility might both be realized.

Background Motor Neurone Disease (MND) is a life-shortening condition with no cure. Consequently, hospice and palliative care are recommended from diagnosis. Family carers provide vital support for people with MND but caregiving can be very physically and mentally demanding. It is therefore crucial to ensure healthcare practitioners (HCPs) can provide timely support to carers fitting their individual needs. Currently there are no UK interventions for this. Aim To adapt an existing Carer Support Needs Assessment Tool (CSNAT) intervention for comprehensive person-centred carer to support the needs and situation of family carers of people with MND. Methods Stages: Focus groups and interviews with 33 carers (14 bereaved, 19 current carers) to capture their self–defined needs, key points of change during patient’s illness, and main support services. Workshops with HCPs (N=22) and carer advisors (N=19) to inform materials and procedures for MND carer assessment and support. Results Stage 1: Carers’ experience was one of dealing with a devastating diagnosis, a constantly changing situation with heavy dependence on them as carers, and with little consideration of their separate support needs. Carers’ support needs mainly mapped onto CSNAT domains, but some MND carers experienced relationship issues warranting further consideration. Stage 2 (on-going) will review carer advice on the need for a further CSNAT domain to address relationship issues; HCP and carers’ views obtained at workshop discussions explore when, where, how and by whom MND carer assessment and support should best be provided in a practice context. Conclusions Study findings will provide insights into how MND carers want to be assessed and supported and how HCPs felt this approach could be delivered in practice. Understandings obtained from Stages 1 and 2 will form the basis for an intervention to be tested in a future Stage 3 feasibility study.

Background: Family members provide vital care at end of life, enabling patients to remain at home. Such informal care contributes significantly to the economy while supporting patients’ preferences and government policy. However, the value of care-givers’ contributions is often underestimated or overlooked in evaluations. Without information on the activities and expenditures involved in informal care-giving, it is impossible to provide an accurate assessment of carers’ contribution to end-of-life care. Aim: The aim of this study was to investigate the contributions and expenditure of informal, family care-giving in end-of-life cancer care. Design: A national census survey of English cancer carers was conducted. Survey packs were mailed to 5271 people who registered the death of a relative to cancer during 1–16 May 2015. Data were collected on decedents’ health and situation, care support given, financial expenditure resulting from care, carer well-being and general background information. Results: In all, 1504 completed surveys were returned (28.5%). Over 90% of respondents reported spending time on care-giving in the last 3 months of the decedent’s life, contributing a median 69 h 30 min of care-giving each week. Those who reported details of expenditure (72.5%) spent a median £370 in the last 3 months of the decedent’s life. Conclusion: Carers contribute a great deal of time and money for day-to-day support and care of patients. This study has yielded a unique, population-level data set of end-of-life care-giving and future analyses will provide estimates of the economic value of family care-givers’ contributions.

PURPOSE: Smoking is a major cause of lung cancer, and continued smoking may compromise treatment efficacy and quality of life (health-related quality of life (HRQoL)) in patients with advanced lung cancer. Our aims were to determine (i) preference for treatments which promote quality over length of life depending on smoking status, (ii) the relationship between HRQoL and smoking status at diagnosis (T1), after controlling for demographic and clinical variables, and (iii) changes in HRQoL 6 months after diagnosis (T2) depending on smoking status. METHODS: Two hundred ninety-six patients with advanced lung cancer were given questionnaires to assess HRQoL (EORTC QLQ-C30), time-trade-off for life quality versus quantity (QQQ) and smoking history (current, former or never smoker) at diagnosis (T1) and 6 months later (T2). Medical data were extracted from case records. RESULTS: Questionnaires were returned by 202 (68.2 %) patients at T1 and 114 (53.3 %) at T2. Patients favoured treatments that would enhance quality of life over increased longevity. Those who continued smoking after diagnosis reported worse HRQoL than former smokers or those who never smoked. Smoking status was a significant independent predictor of coughing in T1 (worse in smokers) and cognitive functioning in T2 (better in never smokers). CONCLUSIONS: Smoking by patients with advanced lung cancer is associated with worse symptoms on diagnosis and poorer HRQoL for those who continue smoking. The results have implications to help staff explain the consequences of smoking to patients.

Background Family carers provide substantial support for patients at end-of-life. It is important to understand how caregiving impacts on carers to guide appropriate interventions to improve carer wellbeing. The aims of this study were to investigate levels of psychological distress and predictors of distress during end of life care giving in a national sample of family carers of people with cancer. Methods Four-month post-bereavement postal survey of a national census sample of relatives reporting a death from cancer 1–16th May 2015. Retrospective data collected included carer demographics, carers’ psychological distress (GHQ-12), care giving hours and tasks, out of pocket expenses, support from informal and formal care, other demands on carers’ time (work, other caregiving responsibilities, voluntary work), opportunities for respite, patient symptoms and activities of daily living (ADL). Exploratory univariate analyses were used to describe the data and inform multivariate analysis. Results Surveys were completed by 1504 (28.5%) of 5271 carers. Carers’ median GHQ distress score was 7 (IQR 4–9), where a score>=4 indicates ‘caseness’ for psychological distress. Univariate analysis results at p Conclusion A considerable majority of family carers suffer clinically significant levels of psychological distress during end of life care giving. Objective care burden in the form of total hours of caregiving is associated with increased distress. Being female and caring for a patient with psychological symptoms appears to increase distress, whereas support from formal care services can ameliorate distress. Whilst the final model explains a modest amount of variance in carer distress, it indicates that reduction in objective care burden and support from services can have an important, positive impact. The study was funded by Dimbleby Cancer Care; NIHR CLAHRC Greater Manchester

Introduction Given poor survival rates for lung cancer, health-related quality of life (HRQoL) is very important. Smoking is prevalent among those diagnosed with lung cancer, and continued smoking is associated with compromised HRQoL in other patient groups. Aims A systematic review was conducted to determine: (i) differences in HRQoL between lung cancer patients who smoke compared with those who quit or never smoked and (ii) changes in HRQoL in patients who continue to smoke after diagnosis compared with those who quit or never smoked. Method Scopus, Medline, PubMed, PsychINFO and Web of Knowledge from January 1995 to June 2010 were searched. The included studies were assessed and given a score for quality. Results Eight studies met the inclusion criteria. Four studies showed that lung cancer patients who smoked report impaired HRQoL compared with those who never smoked or had quit. Smokers reported significantly lower HRQoL than former smokers, who in turn reported lower HRQoL than never smokers. This finding remained consistent over time. Conclusions When taking account of methodological quality, smoking is associated with poorer HRQoL in lung cancer patients. These results suggest that programmes are needed to address the specific support needs of this group and promote HRQoL during their final months. Longitudinal research is necessary to further understand the association between smoking and HRQoL.

IntroductionFamily carers provide vital support for people with Motor Neurone Disease (MND) but caregiving can be very physically and mentally demanding. It is therefore crucial to ensure healthcare practitioners (HCPs) can provide timely support to carers fitting their individual needs. Currently there are no UK interventions for this.AimTo adapt an existing carer support needs assessment tool (CSNAT) intervention to support the needs and situation of family carers of people with MND.MethodsStages:Focus groups and interviews with 33 carers (14 bereaved 19 current carers) to capture support needs key points of change during patient’s illness and main support services.Workshops with HCPs (N=17 recruited to date) and carer advisors (N=19) to inform materials and procedures for MND carer assessment and support.ResultsStage 1: Carers’ experience was one of dealing with a devastating diagnosis a constantly changing situation with heavy dependence on them as carers and with little consideration of their separate support needs. Carers’ support needs mainly mapped onto CSNAT domains but MND carers may experience relationship issues warranting further consideration. Stage 2 will integrate HCP and carers’ views on when where how and by whom MND carer assessment and support should best be provided.ConclusionsFindings to be presented from Stages 1 and 2 will provide insights into how MND carers want to be assessed and supported. This will form the basis for an intervention to be tested in a future Stage 3 feasibility study.FunderMarie Curie Research Fund/Motor Neurone Disease Association

IntroductionThe Carer Support Needs Assessment Tool (CSNAT) intervention requires a change in practice to a carer-centred process of assessment and support.1-3 An online toolkit was developed to guide palliative services through the process of implementing the CSNAT intervention.AimsExplore the feasibility and acceptability of delivering implementation training through an online toolkit format.MethodsThe online toolkit has two learning components: (1) Individual: knowledge for practitioners to use the intervention; (2) Organisational: to assist a project team to plan pilot and sustain implementation. Five UK palliative care services participated; 2–4 practitioners from each completed the toolkit. Online survey administered upon completion of each learning component for feedback on content followed by telephone interview.Results15 practitioners completed ‘Learning component 1’ survey 14 completed ‘Learning component 2’ survey and 13 were interviewed. Feedback on content was positive. Online learning suitability was influenced by resource availability the nature/size of the team and individual learning styles. Variation in location of completion (work/home or both) was partly explained by availability of IT equipment space and time within the organisation. Whilst the majority of participants saw the value of online learning some had a preference for face-to-face delivery and so blended learning to include group discussions was deemed appropriate.ConclusionsWhilst online learning is welcomed by practitioners organisations need to ensure sufficient resources are available to enable completion and that it is given the same priority as attendance at face-to-face workshops. Blended learning may help accommodate different learning preferences.FunderNIHR CLARHC Greater ManchesterReferences. Ewing G, Grande G. Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: A qualitative study. Palliative Medicine2013;27(3):244–56.. Ewing G, Brundle C, Payne S, Grande G. The Carer Support Needs Assessment Tool (CSNAT) for use in palliative and end-of-life care at home: A validation study. Journal of Pain and Symptom Management2013;46(3):395–405.. Ewing G, Austin L, Diffin J, Grande G. Developing a person-centred approach to carer assessment and support. British Journal of Community Nursing2015;20(12):580–4.

Background Lung cancer is the most common cancer and smoking is the principal cause. Due to poor survival rates, symptom palliation and promotion of health-related quality of life (HRQoL) are primary outcomes for lung cancer patients. Given the established relationship between smoking and lung cancer, patients who have smoked may feel stigmatised or guilty after diagnosis, and more pessimistic about their illness and likely outcomes. This may have adverse implications for HRQoL. Objectives We explored HRQoL and support experiences among newly diagnosed patients with advanced lung cancer. Design Semistructured interviews were conducted with nine patients and analysed using interpretative phenomenological analysis. Results Patients described the physical, emotional and social impact of disease on HRQoL. Fear of compromising their immune system and adjusting to new relationship roles had a wide-ranging effect on patients’ HRQoL. Patients acknowledged links between lung cancer and smoking but some continued to smoke. They were sensitive to the opinions of medical staff about smoking especially those who continued to smoke or recently quit. Conclusions We conclude that staff should give clearer advice about the adverse implications of continued smoking. We discuss the potential value of diagnosis as a teachable moment for promoting smoking cessation among patients and family members.

6113 Background: Adverse publicity about smoking may lead to feelings of guilt among lung cancer patients or pessimism about their future, potentially compromising health-related quality of life (QoL) and adherence with medical advice. QoL is an important outcome in clinical trials, particularly where survival rates are low. We aim to compare QoL and illness perceptions of lung cancer patients depending on smoking history. Methods: Clinical data, measures of QoL (EORTC-QLQ-C30+LC13) and illness perceptions (Brief IPQ – includes items to assess perceived severity, causality, timeline, understanding, emotional impact, and control over illness) were completed by 190 newly diagnosed lung cancer patients (Non-small cell: 75%; Mean age: 68 years, range: 48-85 years; 58% males). Of these, 24% were current smokers, 69% former smokers, and 7% never smoked. Results: Although overall QoL was similar between the three smoker groups, there was a significant effect of smoking status on QoL subscale emotional function (EF)(F(2,168)=4.08,p=.019). Those who never smoked had significantly higher EF than current smokers (p=.03). There was also a significant effect of smoking history on cough (F(2,166);=5.40 ,p=.005) with smokers reporting significantly greater levels than former smokers (p=.004). Smokers were more likely than former smokers (p=.015) to attribute their lung cancer to smoking (F(2,161)=16.49,p