Adaptation of the Carers' Alert Thermometer (CAT) for use with the family caregivers of stroke survivors (CAT-S): An action research study

Abstract Background An estimated 1.2 million stroke survivors living in the United Kingdom (UK), currently rely on family caregivers for daily support. The needs of stroke family caregivers are not routinely assessed by most stroke services. An early identification of their needs and support is crucial to maintain their well-being and caregiver role. At present, stroke-specific caregiver screening tools are lacking. Aim To adapt the Carers’ Alert Thermometer (CAT), a short screening tool developed in the context of end-of-life care and develop the CAT-S for use with stroke family caregivers. Methods This was a multi-phase study, underpinned by principles of action research. Between February 2016 to December 2017 qualitative and quantitative data were collected sequentially from purposive samples of stroke family caregivers (n=76) and staff working within stroke services (n=238) in the UK. Semi-structured interviews were conducted to inform the contents of the CAT-S. Key items for inclusion were identified through a modified Delphi survey and consultation with an expert panel. The CAT-S was then piloted in North West England to test its usability and usefulness in practice to identify the needs of family caregivers of stroke survivors. Thematic analysis and content analysis were used to analyse qualitative data. Quantitative data were analysed using descriptive statistics. Findings The CAT-S comprises the key challenges that are experienced by stroke family caregivers. Additional items that were not present on the original CAT were identified and included. These were the training needs of family caregivers to provide care and support for their emotional needs. The CAT-S was found to be useful and acceptable by both staff and stroke family caregivers and resulted in action plans and support being provided. The CAT-S is a potentially valuable tool in prioritising family caregivers requiring comprehensive assessments