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Challenges of Caregivers Regarding Homecare to Type 1 Diabetic Children in Vhembe District, South Africa: A Qualitative Study Report. NURSING REPORTS 2022; 12:884-893. [PMID: 36412804 PMCID: PMC9680399 DOI: 10.3390/nursrep12040085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Worldwide, type 1 diabetes mellitus disease is a devastating health condition for both the diagnosed children and caregivers taking care of them. These challenges were drastically affecting caregivers in rendering the required homecare service for their patients. Caring for a child with diabetes mellitus often hurts the caregivers and other family members. Aim: This study aimed to explore the challenges experienced by caregivers during the provision of care to type 1 diabetic children. Setting: The study was conducted in selected health facility of Vhembe District, South Africa. Methods: A qualitative design that was both descriptive and exploratory was used. Non-probability purposive sampling was used to select the caregivers who were taking care of children with type 1 diabetes mellitus at their homes. Semi-structured interviews were conducted with 15 participants from the Vhembe district of Limpopo province. Results: Caregivers experienced various challenges related to re-admission, poor understanding of medication, low level of literacy, committed mistakes, poor adherence, and fear of giving an injection. Conclusion: It is imperative to educate the caregivers on the care of children with type 1 diabetes mellitus for them to be competent and knowledgeable in assisting their diabetic children at home.
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Access to palliative care medicines in the community: an evaluation of practice and costs using case studies of service models in England. Int J Nurs Stud 2022; 132:104275. [DOI: 10.1016/j.ijnurstu.2022.104275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/22/2022] [Accepted: 04/22/2022] [Indexed: 11/23/2022]
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Yardley S, Francis SA, Dean Franklin B, Ogden M, Kajamaa A, Mattick K. Getting palliative medications right across the contexts of homes, hospitals and hospices: protocol to synthesise scoping review and ethnographic methods in an activity theory analysis. BMJ Open 2022; 12:e061754. [PMID: 35301215 PMCID: PMC8932278 DOI: 10.1136/bmjopen-2022-061754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Prescribing and medication use in palliative care is a multistep process. It requires systems coordination and is enacted through activities of patients, informal carers and professionals. This study compares practice to idealised descriptions of what should happen; identifying when, how and why process disturbances impact on quality and safety. Our objectives are to:Document an intended model (phase 1, scoping review).Refine the model with study of practice (phase 2, ethnography).Use the model to pinpoint 'hot' (viewed as problematic by participants) and 'cold' spots (observed as problematic by researchers) within or when patients move across three contexts-hospice, hospital and community (home).Create learning recommendations for quality and safety targeted at underlying themes and contributing factors. METHODS AND ANALYSIS The review will scope Ovid Medline, CINAHL and Embase, Google Scholar and Images-no date limits, English language only. The Population (palliative), Concept (medication use), Context (home, hospice, hospital) framework defines inclusion/exclusion criteria. Data will be extracted to create a model illustrating how processes ideally occur, incorporating multiple steps of typical episodes of prescribing and medication use for symptom control. Direct observations, informal conversations around acts of prescribing and medication use, and semistructured interviews will be conducted with a purposive sample of patients, carers and professionals. Drawing on activity theory, we will synthesise analysis of both phases. The analysis will identify when, how and why activities affect patient safety and experience. Generating a rich multivoiced understanding of the process will help identify meaningful targets for improvement. ETHICS AND DISSEMINATION Ethical approval granted by the Camden & Kings Cross NHS Regional Ethics Committee (21/LO/0459). A patient and public involvement (PPI) coinvestigator, a multiprofessional steering group and a PPI engagement group are working with the research team. Dissemination of findings is planned through peer-reviewed publications and a stakeholder (policymakers, commissioners, clinicians, researchers, public) report/dissemination event.
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Affiliation(s)
- Sarah Yardley
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Central & North West London NHS Foundation Trust, London, London
| | - Sally-Anne Francis
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Bryony Dean Franklin
- University College London School of Pharmacy, London, UK
- Pharmacy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Margaret Ogden
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Anu Kajamaa
- Faculty of Education, University of Oulu, Oulu, Finland
| | - Karen Mattick
- College of Medicine & Health, University of Exeter, Exeter, UK
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Cormican O, Meskell P, Dowling M. Psychosocial vulnerability among carers of persons living with a chronic illness: A scoping review. Int J Nurs Pract 2021; 28:e13024. [PMID: 34741488 DOI: 10.1111/ijn.13024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 09/13/2021] [Accepted: 09/25/2021] [Indexed: 01/02/2023]
Abstract
AIMS To outline and examine evidence related to the meaning of 'psychosocial vulnerability' among caregivers of persons with chronic illnesses. BACKGROUND The number of informal caregivers continues to rise globally. Their risk of psychosocial vulnerability is frequently overlooked, but understanding their psychosocial vulnerability may offer insights into meeting their needs. DESIGN Scoping review following the PRISMA 2020 extension guidelines. DATA SOURCES The databases CINAHL, Embase, Medline/Pubmed, Cochrane Library, PsycINFO, Web of Science, Google Scholar, Lenus and ProQuest were systematically searched to identify original research. No date limit was set, and 23 studies were included. REVIEW METHODS A five-step approach using the Arksey and O'Malley framework. Thematic analysis guided data analysis. RESULTS Carers' psychosocial vulnerability occurs when they experience barriers to resources while access and use of supports reduce risk. Antecedents of psychosocial vulnerability include a carer's age and sex, socioeconomic status and their health and wellbeing. Psychosocial vulnerability affects carers' relationships and causes personal losses. CONCLUSIONS The concept of carers' psychosocial vulnerability is complex. Recognition of carers at risk for psychosocial vulnerability would help nurses direct relevant support and information to carers who need it most.
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Affiliation(s)
| | - Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, NUI Galway, Galway, Ireland
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Ogi M, Campling N, Birtwistle J, Richardson A, Bennett MI, Santer M, Latter S. Community access to palliative care medicines-patient and professional experience: systematic review and narrative synthesis. BMJ Support Palliat Care 2021:bmjspcare-2020-002761. [PMID: 33775932 DOI: 10.1136/bmjspcare-2020-002761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/11/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Providing palliative care patients living at home with timely access to medicines is critical to enable effective symptom management, minimise burden and reduce unplanned use of healthcare services. Little is known about how diverse community-based palliative care models influence medicine access. OBJECTIVE To produce a critical overview of research on experiences and outcomes of medicine access in community-based palliative care models of service delivery through a systematic review and narrative synthesis. METHODS MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library databases and grey literature were systematically searched for all types of studies. Study quality was assessed using the Mixed Methods Appraisal Tool; a narrative synthesis was used to integrate and summarise findings. RESULTS 3331 articles were screened; 10 studies were included in the final sample. Studies included a focus on community pharmacy (n=4), hospice emergency medication kits (HEMKs) in the home (n=3), specialist community nurse prescribers (n=1), general practice (n=1) and one study included multiple service delivery components. Community pharmacy was characterised by access delays due to lack of availability of medicine stock and communication difficulties between the pharmacy and other healthcare professionals. HEMKs were perceived to reduce medicine access time out of hours and speed symptom control. However, the majority of studies comprised small, local samples, largely limited to self-reports of health professionals. There was a lack of data on outcomes, and no comparisons between service delivery models. CONCLUSIONS Further research is required to understand which models facilitate rapid and efficient access to medicines for community-based palliative care patients.
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Affiliation(s)
- Mizue Ogi
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Natasha Campling
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jakki Birtwistle
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael I Bennett
- Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Miriam Santer
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - Susan Latter
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
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Samper-Ternent R, Gonzalez-Gonzalez C, Zazueta JD, Wong R. Factors associated with pain at the end-of-life among older adults in Mexico. Public Health 2021; 191:68-77. [PMID: 33540186 DOI: 10.1016/j.puhe.2020.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/30/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The goal of care at the end-of-life has changed in recent years to encompass not only the relief of suffering but also improve the quality of death. Palliative care offers a coordinated and multidisciplinary approach to improving the quality of life and quality of care of individuals and their families facing illness at the end-of-life. This manuscript examines the end-of-life of older adults in Mexico and the factors associated with pain in this period of their life. STUDY DESIGN We used data from the Mexican Health and Aging Study (MHAS), a longitudinal panel study of adults 50 years and older in Mexico that is nationally representative of urban and rural areas and includes a next-of-kin questionnaire that captures the conditions during the last year of life of those who died. We used all four waves of data to construct a group of deceased individuals between 2001 and 2015, including information in the wave immediately before death and a complete next-of-kin questionnaire. We studied factors associated with pain at the end-of-life in this group. METHODS The dependent variable was pain reported over time among deceased individuals. We constructed pain categories based on whether the pain was reported in one or two waves (occasional and persistent), and the pain intensity reported (mild, moderate, or severe). We included independent variables previously reported to be related to pain, including sociodemographic, functional, and health characteristics. We used descriptive statistics and a multinomial regression model to examine the factors associated with pain in this group. RESULTS Pain was reported by 71.5% of older adults who died between 2001 and 2015. The prevalence of pain differed significantly by sociodemographic characteristics. Women had 1.69 higher odds of reporting severe pain than men. Compared to those with zero years of education, the odds of reporting severe pain were 0.72 for those with 1-6 years of education (P < 0.05) and 0.55 for those with more than 7 years (P < 0.001). Poor self-reported health, arthritis, taking more medications, depression, and functional limitations in the wave prior to death were associated with higher odds of persistent pain at the end-of-life (P < 0.05). Conversely, older age, more years of education, and diabetes were associated with lower odds of persistent pain (P < 0.001). CONCLUSIONS The prevalence of pain among older Mexican adults is high at the end-of-life. Sociodemographic factors, some chronic diseases, number of medications, psychosocial factors, and functional status impact the odds of reporting pain in this group at the end-of-life. Providing education to families on psychosocial interventions to improve the quality of care at the end-of-life is a pressing need in Mexico. These findings provide information to help policymakers and healthcare providers in Mexico improve the quality of care at the end-of-life.
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Affiliation(s)
- R Samper-Ternent
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA.
| | | | - J D Zazueta
- Netherlands Interdisciplinary Demographic Institute, The Hague, Netherlands
| | - R Wong
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA; Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA
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Latter S, Campling N, Birtwistle J, Richardson A, Bennett MI, Ewings S, Meads D, Santer M. Supporting patient access to medicines in community palliative care: on-line survey of health professionals' practice, perceived effectiveness and influencing factors. BMC Palliat Care 2020; 19:148. [PMID: 32972414 PMCID: PMC7517636 DOI: 10.1186/s12904-020-00649-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Patient access to medicines at home during the last year of life is critical for symptom control, but is thought to be problematic. Little is known about healthcare professionals’ practices in supporting timely medicines access and what influences their effectiveness. The purpose of the study was to evaluate health professionals’ medicines access practices, perceived effectiveness and influencing factors. Methods On-line questionnaire survey of health care professionals (General Practitioners, Community Pharmacists, community-based Clinical Nurse Specialists and Community Nurses) delivering end-of-life care in primary and community care settings in England. Quantitative data were analysed using descriptive statistics. Results One thousand three hundred twenty-seven responses were received. All health professional groups are engaged in supporting access to prescriptions, using a number of different methods. GPs remain a predominant route for patients to access new prescriptions in working hours. However, nurses and, increasingly, primary care-based pharmacists are also actively contributing. However, only 42% (160) of Clinical Nurse Specialists and 27% (27) of Community Nurses were trained as prescribers. The majority (58% 142) of prescribing nurses and pharmacists did not have access to an electronic prescribing system. Satisfaction with access to shared patient records to facilitate medicines access was low: 39% (507) were either Not At All or only Slightly satisfied. Out-of-hours specialist cover was reported by less than half (49%; 656) and many General Practitioners and pharmacists lacked confidence advising about out-of-hours services. Respondents perceived there would be a significant improvement in pain control if access to medicines was greater. Those with shared records access reported significantly lower pain estimates for their caseload patients. Conclusions Action is required to support a greater number of nurses and pharmacists to prescribe end-of-life medicines. Solutions are also required to enable shared access to patient records across health professional groups. Coverage and awareness of out-of-hours services to access medicines needs to be improved.
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Affiliation(s)
- Sue Latter
- School of Health Sciences, University of Southampton, Building 67, Highfield, Southampton, SO17 1BJ, England.
| | - Natasha Campling
- School of Health Sciences, University of Southampton, Building 67, Highfield, Southampton, SO17 1BJ, England
| | - Jacqueline Birtwistle
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL, England
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Building 67, Highfield, Southampton, SO17 1BJ, England.,University Hospitals Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, England
| | - Michael I Bennett
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL, England
| | - Sean Ewings
- Faculty of Medicine, University of Southampton, Building 85, Southampton, SO17 1BJ, England
| | - David Meads
- School of Medicine, University of Leeds, Worsley Building, Leeds, LS2 9JT, England
| | - Miriam Santer
- Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, England
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van Dongen SI, de Nooijer K, Cramm JM, Francke AL, Oldenmenger WH, Korfage IJ, Witkamp FE, Stoevelaar R, van der Heide A, Rietjens JA. Self-management of patients with advanced cancer: A systematic review of experiences and attitudes. Palliat Med 2020; 34:160-178. [PMID: 32009565 PMCID: PMC7433395 DOI: 10.1177/0269216319883976] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with advanced cancer are increasingly expected to self-manage. Thus far, this topic has received little systematic attention. AIM To summarise studies describing self-management strategies of patients with advanced cancer and associated experiences and personal characteristics. Also, to summarise attitudes of relatives and healthcare professionals towards patient self-management. DESIGN A systematic review including non-experimental quantitative and qualitative studies. Data were analysed using critical interpretive synthesis. Included studies were appraised on methodological quality and quality of reporting. DATA SOURCES MEDLINE, Embase, Cochrane Central, PsycINFO, CINAHL, Web of Science and Google Scholar (until 11 June 2019). RESULTS Of 1742 identified articles, 31 moderate-quality articles describing 8 quantitative and 23 qualitative studies were included. Patients with advanced cancer used self-management strategies in seven domains: medicine and pharmacology, lifestyle, mental health, social support, knowledge and information, navigation and coordination and medical decision-making (29 articles). Strategies were highly individual, sometimes ambivalent and dependent on social interactions. Older patients and patients with more depressive symptoms and lower levels of physical functioning, education and self-efficacy might have more difficulties with certain self-management strategies (six articles). Healthcare professionals perceived self-management as desirable and achievable if based on sufficient skills and knowledge and solid patient-professional partnerships (three articles). CONCLUSION Self-management of patients with advanced cancer is highly personal and multifaceted. Strategies may be substitutional, additional or even conflicting compared to care provided by healthcare professionals. Self-management support can benefit from an individualised approach embedded in solid partnerships with relatives and healthcare professionals.
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Affiliation(s)
- Sophie I van Dongen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kim de Nooijer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jane M Cramm
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Amsterdam Public Health (APH) Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Wendy H Oldenmenger
- Faculty of Nursing and Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frederika E Witkamp
- Faculty of Nursing and Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Rik Stoevelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Judith Ac Rietjens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Abstract
There is a growing number of people who need access to high-quality endof-life care in the home setting. This requires timely assessments of needs, ensuring good symptom management and recognising the roles undertaken by carers. For some patients, a range of medications may need to be put in place to relieve end-of-life symptoms, using 'anticipatory prescribing'. District nurses must ensure that they acknowledge the patient's voiced preferences and be mindful of the safety issues that arise with the supply of controlled drugs in the home. This article highlights the challenges faced by district nurses providing or dealing with anticipatory prescribing during end-of-life care.
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Affiliation(s)
- Ben Bowers
- PhD Student, National Institute for Health Research School for Primary Care Research, and Queen's Nurse, University of Cambridge
| | - Alison While
- Emeritus Professor of Community Nursing, King's College London
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10
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Interventionen zur Förderung des Selbstmanagements bei Tumorschmerz. Schmerz 2019; 33:255-260. [DOI: 10.1007/s00482-019-0372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nurses' Perspectives on Family Caregiver Medication Management Support and Deprescribing. J Hosp Palliat Nurs 2019; 21:312-318. [PMID: 31033645 DOI: 10.1097/njh.0000000000000574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Nurses who care for patients with life-limiting illness operate at the interface of family caregivers (FCGs), patients, and prescribers and are uniquely positioned to guide late-life medication management, including challenging discussions about deprescribing. The study objective was to describe nurses' perspectives about their role in hospice FCG medication management. Content analysis was used to analyze qualitative interviews with nurses from a parent study exploring views on medication management and deprescribing for advanced cancer patients. Ten home and inpatient hospice nurses, drawn from 3 hospice agencies and their referring hospital systems in New England, were asked to describe current practices of medication management and deprescribing and to evaluate a pilot tool to standardize hospice medication review. Analysis of the 10 interviews revealed that hospice nurses are receptive to a standardized approach for comprehensive medication review upon hospice transition and responded favorably to opportunities to discuss medication discontinuation with FCGs and prescribers. Effective framing for discussions included focus on reducing harmful and nonessential medications and reducing caregiver burden. Results indicate that nurses who care for hospice-eligible and enrolled patients are willing to discuss deprescribing with FCGs and prescribers when conversations are framed around medication harms and their impact on quality of life.
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Wilson E, Caswell G, Turner N, Pollock K. Managing Medicines for Patients Dying at Home: A Review of Family Caregivers' Experiences. J Pain Symptom Manage 2018; 56:962-974. [PMID: 30217417 DOI: 10.1016/j.jpainsymman.2018.08.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022]
Abstract
CONTEXT Increased life expectancy, technical advances in treatment and symptom control, and the extension of palliative care in community settings not only lengthen life but also make it possible for many patients to be cared for, and to die, at home. Moreover, death increasingly occurs in late old age and after a prolonged period of comorbidity and/or frailty. This has far-reaching consequences for the way that professional services are resourced and organized and for the informal carers who are often responsible for providing the greater part of patient care, including management of complex medication regimes. OBJECTIVES To explore the literature focused on family caregivers' (FCGs) experiences of medication management for patients being cared for and dying at home. METHODS This literature review takes a critical interpretive synthesis approach to the review of 15 identified articles. RESULTS Findings show that FCGs can struggle to manage medications for someone who is dying at home, yet there is an expectation that they will take on these roles and are often judged by professional standards. Five key themes identified particular issues around administration, organizational skills, empowerment, relationships, and support. CONCLUSION As increasing demands are placed on FCGs, there remains limited acknowledgment or understanding of the challenges they face, how they cope, or could be best supported. Alongside training, FCGs need access to 24 hours of support and medication reviews to rationalize unnecessary medications. Furthermore, the ethical challenges arising from administering medicines at the end of life also need to be acknowledged and discussed.
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Affiliation(s)
- Eleanor Wilson
- Nottingham Centre for the Advancement of Research in End of Life Care (NCARE), School of Health Sciences, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, United Kingdom.
| | - Glenys Caswell
- Nottingham Centre for the Advancement of Research in End of Life Care (NCARE), School of Health Sciences, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - Nicola Turner
- Nottingham Centre for the Advancement of Research in End of Life Care (NCARE), School of Health Sciences, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
| | - Kristian Pollock
- Nottingham Centre for the Advancement of Research in End of Life Care (NCARE), School of Health Sciences, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, United Kingdom
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