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Table 1 Items of the risk and needs assessment form for caregiversa

From: A process evaluation of systematic risk and needs assessment for caregivers in specialised palliative care

What is your relation to you ill relative?  
Do you have children in your household that you are (partly) responsible for?
  Not at all A little Some A lot
Do you need information about your relative’s disease and/or your current situation?
Do you and your relative need further help to alleviate disease symptoms, including giving medicine?
Do you need information about who to contact if you need help, including at night?
Do you need help to clarify economic, legal, housing or work-related issues?
Do you need knowledge about what to expect in the course of your relative’s disease?
Do you need support to talk with your relative about his/her disease and its consequences?
Do you feel as if you lack support from family and friends?
Do you feel overwhelmed by practical tasks or tasks in relation to caring for your ill relative?
Do you need help to take breaks from caring for your ill relative, or taking care of your own needs?
Do you need help to cope with your own thoughts, feelings or worries?
Do you have thoughts about religion/spirituality or life and death, that you feel you need to talk about?
Do you feel depressed?
Have you experienced significant losses earlier in your life that places a strain on you now? (e.g. regarding health, job, divorce, or death?)
Do you suffer from a mental illness (e.g. depression, stress or anxiety) that has been diagnosed by a medical doctor? Yes ⎕ No ⎕
If yes, which illness?  
  1. aThe Danish risk and needs assessment form was translated from Danish into English for the purpose of this article