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Starr LT, Washington KT, Jabbari J, Benson JJ, Oliver DP, Demiris G, Cagle JG. Pain Management Education for Rural Hospice Family Caregivers: A Pilot Study With Embedded Implementation Evaluation. Am J Hosp Palliat Care 2024; 41:619-633. [PMID: 37491002 PMCID: PMC11032627 DOI: 10.1177/10499091231191114] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Assessing and managing hospice patients' pain is a common source of anxiety among hospice family caregivers (HFCGs), especially caregivers in rural communities who face special challenges including distance, limited access, and concerns about opioid misuse. OBJECTIVE To pilot test Ready2Care, a pain management education intervention for rural HFCGs. We sought to determine whether there was a signal of benefit for clinically-relevant outcomes and to identify contextual factors pertinent to conducting a future randomized clinical trial of Ready2Care. METHODS We conducted a multi-method, single-arm study, enabling completion of paired t-tests comparing pre- and post-intervention measures of caregiver anxiety, pain management self-efficacy, barriers to pain management, and reports of patient pain intensity and corresponding patient and caregiver distress. We concurrently conducted an embedded implementation evaluation via calculation of descriptive statistics (recruitment and retention data) and directed content analysis of brief caregiver interviews. RESULTS Twenty-seven (n = 27) HFCGs participated; 15 completed the study. Among completers, significant improvement was observed in patient pain intensity (average 1.4 points decrease on 0-10 scale) and in overall pain experience. No statistically significant changes were detected in caregiver anxiety, barriers to pain management, or pain management self-efficacy. Facilitators to successful conduct of a future clinical trial included high acceptability of Ready2Care, driven by its perceived clarity and relevance to caregivers' concerns. Barriers included lower-than-anticipated accrual and an attrition rate of nearly 44%. CONCLUSION A multisite clinical trial of Ready2Care is warranted; however, its success may require more effective recruitment and retention strategies for rural caregiver participants.
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Affiliation(s)
- Lauren T. Starr
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - JoAnn Jabbari
- Washington University in St Louis School of Medicine, St Louis, MO, USA
- Barnes-Jewish College, Goldfarb School of Nursing, St Louis, MO, USA
| | | | - Debra Parker Oliver
- Washington University in St Louis School of Medicine, St Louis, MO, USA
- Barnes-Jewish College, Goldfarb School of Nursing, St Louis, MO, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John G. Cagle
- Center to Advance Chronic Pain Research, University of Maryland, School of Social Work, Baltimore, MD, USA
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Chi NC, Nakad L, Han S, Washington K, Hagiwara Y, Riffin C, Oliver DP, Demiris G. Family Caregivers' Challenges in Cancer Pain Management for Patients Receiving Palliative Care. Am J Hosp Palliat Care 2023; 40:43-51. [PMID: 35503240 PMCID: PMC10201988 DOI: 10.1177/10499091221094564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
CONTEXT Family caregivers (FCs) of cancer patients play a crucial role in managing their care partner's pain, but little research has examined FCs' specific challenges regarding the provision of pain management (PM) to cancer patients receiving palliative care. OBJECTIVES To determine the demographic and clinical characteristics of FCs who encounter challenges in PM and to elucidate the specific challenges that FCs face when managing pain for their care partner with cancer. METHODS We conducted a secondary analysis of 40 interview transcripts of FCs who were caring for persons with cancer. Interviews were audio-recorded, transcribed verbatim, and analyzed using deductive thematic analysis. RESULTS The three major identified challenges to PM for FCs of persons with cancer were: (1) communication and teamwork issues, (2) caregiver-related issues, and (3) patient-related issues. Communication and teamwork issues encompassed caregivers' receipt of inadequate information regarding PM, and inappropriate and ineffective communication from the healthcare team. Caregiver issues pertained to caregivers' fear and beliefs, concurrent responsibilities, and lack of pain-related knowledge and skills. Patient issues related to their own fear and beliefs, psychological and physiological well-being, adherence to medications, and reluctance to report pain. CONCLUSION Findings of this study have implications for future research and practice related to cancer PM in palliative care. Results suggest the need for FC training in PM as well as clear clinical practice guidelines and resources to help providers prepare, educate, and communicate with FCs regarding PM.
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Affiliation(s)
- Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Lynn Nakad
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Soojeong Han
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Karla Washington
- School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Yuya Hagiwara
- College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Mather H, Kleijwegt H, Bollens-Lund E, Kelley AS, Ornstein KA. Symptom Management Experience of End-of-Life Family Caregivers: A Population-Based Study. J Pain Symptom Manage 2022; 64:513-520. [PMID: 35944883 PMCID: PMC10212333 DOI: 10.1016/j.jpainsymman.2022.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/20/2022] [Accepted: 07/31/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT In the United States, 30% of all deaths occur at home. Effective symptom management is integral to quality end-of-life (EOL) care. Family caregivers play a major role in EOL symptom management. Recent federal policies emphasize the need to improve training and support for family caregivers. OBJECTIVES In a nationally representative sample: 1) Characterize the population of caregivers assisting with and reporting difficulty in symptom management at the end of life; and 2) Assess caregiver and care recipient characteristics associated with caregiver report of difficulty. METHODS Cross-sectional analysis of data from the National Health and Aging Trends Study and National Study of Caregiving. Multivariable logistic regression to assess association between care recipient and caregiver characteristics and caregiver report of difficulty. RESULTS Caregivers (n = 214) were mean age 57.1 years, 74% female, and 86% white non-Hispanic. Over 2 million family caregivers provided assistance with symptom management in the last month of life in 2017; 78% reported difficulty. Non-Hispanic Black caregivers (aOR 0.24, 95% CI 0.08-0.75), Hispanic caregivers (0.13, 0.03-0.56), and caregivers with lower than high school education (0.26, 0.11-0.63) were less likely to report difficulty. Caregivers of care recipients who received paid care (3.37, 1.30-8.69) were more likely to report difficulty. Receipt of training and support services (1.80, 0.83-3.93) and hospice (1.83, 0.82-4.07) were not associated with caregiver report of difficulty. CONCLUSION These findings underscore the need to improve training and support for family caregivers in EOL symptom management.
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Affiliation(s)
- Harriet Mather
- Icahn School of Medicine at Mount Sinai (H.M., H.K., E.B.L.), Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA.
| | - Hannah Kleijwegt
- Icahn School of Medicine at Mount Sinai (H.M., H.K., E.B.L.), Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA
| | - Evan Bollens-Lund
- Icahn School of Medicine at Mount Sinai (H.M., H.K., E.B.L.), Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA
| | - Amy S Kelley
- Icahn School of Medicine at Mount Sinai (A.S.K), Brookdale Department of Geriatrics and Palliative Medicine, James J Peters VA Medical Center, Bronx, New York, USA
| | - Katherine A Ornstein
- Icahn School of Medicine at Mount Sinai (K.A.O), Brookdale Department of Geriatrics and Palliative Medicine and Department of General Internal Medicine, New York, New York, USA
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Chi NC, Fu YK, Nakad L, Barani E, Gilbertson-White S, Tripp-Reimer T, Herr K. Family Caregiver Challenges in Pain Management for Patients with Advanced Illnesses: A Systematic Review. J Palliat Med 2022; 25:1865-1876. [PMID: 36178473 PMCID: PMC9784612 DOI: 10.1089/jpm.2020.0806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 01/04/2023] Open
Abstract
Although pain management is integral to the caregiving role, there is a paucity of evidence synthesizing specific challenges family caregivers (FCs) face when managing pain for their care partners. This review comprehensively identified and summarized such challenges in the setting of advanced illnesses. Electronic databases (PubMed, CINAHL, PsycINFO, Scopus, and Health and Psychosocial Instruments) were searched using index and keyword methods for all articles published before April 2021. Fifty-five studies were included in this review. Most articles were published within the last 10 years (54%) in community settings, with home hospice care comprising the majority (50%). Most studies included patients with an advanced cancer diagnosis (84%), and 16% of the studies included patients with a noncancer diagnosis. Four major categories of challenges were identified: (1) caregiver-related issues (e.g., fears, beliefs, function), (2) caregivers' limited knowledge and skills in pain management (e.g., verbal and nonverbal pain assessment skills, pharmacological knowledge, documentation, safe management of medication), (3) communication challenges with health care providers, and (4) patient-related issues (e.g., inability to report pain). Many of these challenges have not been fully addressed in prior literature. Thus, this review provides a framework for needed future research to develop interventions that target FCs' specific challenges in providing pain management. The results also highlight a significant lack of research surrounding challenges faced by caregivers of care partners having a noncancer, dementia, or multimorbidity diagnosis.
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Affiliation(s)
- Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Ying-Kai Fu
- College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Lynn Nakad
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Emelia Barani
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | | | | | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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LeBaron V, Alam R, Bennett R, Blackhall L, Gordon K, Hayes J, Homdee N, Jones R, Lichti K, Martinez Y, Mohammadi S, Ogunjirin E, Patel N, Lach J. Deploying the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C) smart health system to support patients and family caregivers in managing pain: A feasibility and acceptability study. (Preprint). JMIR Cancer 2022; 8:e36879. [PMID: 35943791 PMCID: PMC9399893 DOI: 10.2196/36879] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 01/03/2023] Open
Abstract
Background Distressing cancer pain remains a serious symptom management issue for patients and family caregivers, particularly within home settings. Technology can support home-based cancer symptom management but must consider the experience of patients and family caregivers, as well as the broader environmental context. Objective This study aimed to test the feasibility and acceptability of a smart health sensing system—Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C)—that was designed to support the monitoring and management of cancer pain in the home setting. Methods Dyads of patients with cancer and their primary family caregivers were recruited from an outpatient palliative care clinic at an academic medical center. BESI-C was deployed in each dyad home for approximately 2 weeks. Data were collected via environmental sensors to assess the home context (eg, light and temperature); Bluetooth beacons to help localize dyad positions; and smart watches worn by both patients and caregivers, equipped with heart rate monitors, accelerometers, and a custom app to deliver ecological momentary assessments (EMAs). EMAs enabled dyads to record and characterize pain events from both their own and their partners’ perspectives. Sensor data streams were integrated to describe and explore the context of cancer pain events. Feasibility was assessed both technically and procedurally. Acceptability was assessed using postdeployment surveys and structured interviews with participants. Results Overall, 5 deployments (n=10 participants; 5 patient and family caregiver dyads) were completed, and 283 unique pain events were recorded. Using our “BESI-C Performance Scoring Instrument,” the overall technical feasibility score for deployments was 86.4 out of 100. Procedural feasibility challenges included the rurality of dyads, smart watch battery life and EMA reliability, and the length of time required for deployment installation. Postdeployment acceptability Likert surveys (1=strongly disagree; 5=strongly agree) found that dyads disagreed that BESI-C was a burden (1.7 out of 5) or compromised their privacy (1.9 out of 5) and agreed that the system collected helpful information to better manage cancer pain (4.6 out of 5). Participants also expressed an interest in seeing their own individual data (4.4 out of 5) and strongly agreed that it is important that data collected by BESI-C are shared with their respective partners (4.8 out of 5) and health care providers (4.8 out of 5). Qualitative feedback from participants suggested that BESI-C positively improved patient-caregiver communication regarding pain management. Importantly, we demonstrated proof of concept that seriously ill patients with cancer and their caregivers will mark pain events in real time using a smart watch. Conclusions It is feasible to deploy BESI-C, and dyads find the system acceptable. By leveraging human-centered design and the integration of heterogenous environmental, physiological, and behavioral data, the BESI-C system offers an innovative approach to monitor cancer pain, mitigate the escalation of pain and distress, and improve symptom management self-efficacy. International Registered Report Identifier (IRRID) RR2-10.2196/16178
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Affiliation(s)
- Virginia LeBaron
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Ridwan Alam
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Rachel Bennett
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Leslie Blackhall
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Kate Gordon
- Virginia Commonwealth University Health, Richmond, VA, United States
| | - James Hayes
- Trident Systems, Inc, Fairfax, VA, United States
| | - Nutta Homdee
- Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Randy Jones
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Kathleen Lichti
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Yudel Martinez
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Sahar Mohammadi
- Penn Medicine, University of Pennsylvania Health System, Philadelphia, PA, United States
| | - Emmanuel Ogunjirin
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Nyota Patel
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - John Lach
- The George Washington University School of Engineering & Applied Science, Washington, DC, United States
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Riffin C, Patrick K, Lin SL, Reid MC, Herr K, Pillemer KA. Caregiver-provider communication about pain in persons with dementia. DEMENTIA 2022; 21:270-286. [PMID: 34340587 PMCID: PMC9158475 DOI: 10.1177/14713012211036868] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Pain in older persons with dementia is both under-detected and under-managed. Family caregivers can play an important role in addressing these deficiencies by communicating their care recipient's symptoms and behaviors to medical providers, but little is known about how caregivers and providers approach pain-related discussions in the context of dementia. The goal of this study was to explore how ambulatory care providers and family caregivers of persons with dementia view pain communication. METHODS In-depth, semi-structured interviews were conducted with family caregivers (n = 18) and healthcare providers involved in dementia care (n = 16). Interviews focused on three specific content areas: (1) caregivers' roles in communicating about pain in persons with dementia, (2) challenges experienced when communicating about pain in persons with dementia, and (3) strategies and recommendations for optimizing communication in this context. All interviews were audio-recorded, transcribed, and analyzed using the constant comparative method of data analysis. RESULTS Caregivers and providers described various roles that caregivers assumed in communication processes, such as serving as historians, interpreters, and advocates. They identified two key features of problematic communication-receipt of inadequate information and interpersonal conflict about the care recipient's pain-and articulated how ambiguity around pain and dementia, as well as preexisting beliefs and emotions, contributed to communication challenges. They also offered several suggestions to improve caregiver-provider communication processes, including the use of (1) written records to enhance the accuracy of caregivers' reports and ensure that providers had specific information to inform symptom management and treatment plans, (2) pain scales and follow-up discussions to establish baseline data and clarify treatment recommendations, and (3) collaboration and rapport-building strategies to validate the caregivers' contributions and maximize a team-based decision-making. CONCLUSION Receipt of inadequate information and interpersonal conflict are key challenges to caregiver-provider communication regarding pain in persons with dementia. Written records, pain scales, and rapport-building strategies may help to address these challenges.
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Affiliation(s)
- Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Karlee Patrick
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Sylvia L. Lin
- New York University Long Island School of Medicine, Long Island, NY, USA
| | | | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, IA, USA
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Wilson E, Caswell G, Pollock K. The 'work' of managing medications when someone is seriously ill and dying at home: A longitudinal qualitative case study of patient and family perspectives'. Palliat Med 2021; 35:1941-1950. [PMID: 34252329 PMCID: PMC8640265 DOI: 10.1177/02692163211030113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Managing medications can impose difficulties for patients and families which may intensify towards the end of life. Family caregivers are often assumed to be willing and able to support patients with medications, yet little is known about the challenges they experience or how they cope with these. AIM To explore patient and family caregivers' views of managing medications when someone is seriously ill and dying at home. DESIGN A qualitative design underpinned by a social constructionist perspective involving interviews with bereaved family caregivers, patients and current family caregivers. A thematic analysis was undertaken. SETTING/PARTICIPANTS Two English counties. Data reported in this paper were generated across two data sets using: (1) Interviews with bereaved family caregivers (n = 21) of patients who had been cared for at home during the last 6 months of life. (2) Interviews (n = 43) included within longitudinal family focused case studies (n = 20) with patients and current family caregivers followed-up over 4 months. RESULTS The 'work of managing medications' was identified as a central theme across the two data sets, with further subthemes of practical, physical, emotional and knowledge-based work. These are discussed by drawing together ideas of illness work, and how the management of medications can substantially add to the burden placed on patients and families. CONCLUSIONS It is essential to consider the limits of what it is reasonable to ask patients and families to do, especially when fatigued, distressed and under pressure. Focus should be on improving support via greater professional understanding of the work needed to manage medications at home.
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Affiliation(s)
- Eleanor Wilson
- Nottingham Centre for the Advancement of Research in End of Life Care, School of Health Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Glenys Caswell
- Nottingham Centre for the Advancement of Research in End of Life Care, School of Health Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Kristian Pollock
- Nottingham Centre for the Advancement of Research in End of Life Care, School of Health Sciences, University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
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Abstract
BACKGROUND Cancer pain is among the most severe types of pain and is among the most common types of cancer-related problems. Yet, many ambiguities surround the concept of cancer pain and its attributes. OBJECTIVE This study aimed to analyze the concept of cancer pain. METHODS This concept analysis was conducted using the Rodgers' evolutionary method. Nursing, psychology, social sciences, and medicine literature were reviewed through searching online databases. In total, 52 articles were included and analyzed through thematic analysis. RESULTS/CONCLUSION The attributes of cancer pain are known origin, sharp, burning, piercing, or throbbing quality, varying duration (acute, chronic, or breakthrough), intolerability, and moderate to severe intensity. Its antecedents are cognitive system, pain-related beliefs, coping strategies, family and social support, financial status, and cultural, ethnic, racial, and religious values. Its consequences include physical, psychological, existential and spiritual, and social consequences, and reduced quality of life. This concept analysis concludes that cancer pain is different from other types of acute and chronic pain. Thus, specific interventions are needed for its assessment and management. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The results of this concept analysis can broaden the case manager/health care team and other health care providers' knowledge about cancer pain and help them make better decisions and take more effective interventions for its management. The information in the article can be used to inform the case manager/health care team when it may be time to consider palliative care or even hospice care. Also, the information, itself, is crucial for case managers to understand when a patient has cancer pain.
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Affiliation(s)
- Marzieh Khatooni
- Marzieh Khatooni, PhD , is an assistant professor at the Faculty of Nursing & Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
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Orujlu S, Hassankhani H, Rahmani A, Sanaat Z, Dadashzadeh A, Allahbakhshian A. Barriers to cancer pain management from the perspective of patients: A qualitative study. Nurs Open 2021; 9:541-549. [PMID: 34657391 PMCID: PMC8685847 DOI: 10.1002/nop2.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/29/2021] [Indexed: 11/14/2022] Open
Abstract
Aim The aim of this study was to explore the barriers to effective pain management in Iranian people with cancer. Design A qualitative descriptive design was used. Methods This qualitative descriptive study was performed on 14 people with cancer. Data were collected using semi‐structured interviews and analysed by Graneheim and Lundman's content analysis method. Results Four main categories emerged in relation to barriers to pain management from the perspective of people with cancer. Categories included 1) accepting and enduring divine pain, 2) negative attitudes towards the effectiveness of analgesics, 3) patients’ low knowledge of pain self‐management methods and 4) neglected pain management. Barriers to pain management are multidimensional in nature consisting of patients, healthcare providers and system components. Therefore, attempts should be focused on the education of patients and healthcare providers about pain management and eliminating the shortcomings of the healthcare system.
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Affiliation(s)
- Samira Orujlu
- School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Hassankhani
- Emergency Medicine Research Team, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azad Rahmani
- Emergency Medicine Research Team, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zohreh Sanaat
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbas Dadashzadeh
- Emergency Medicine Research Team, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefeh Allahbakhshian
- Emergency Medicine Research Team, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Warner G, Baird LG, McCormack B, Urquhart R, Lawson B, Tschupruk C, Christian E, Weeks L, Kumanan K, Sampalli T. Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis. BMC Palliat Care 2021; 20:114. [PMID: 34271897 PMCID: PMC8285870 DOI: 10.1186/s12904-021-00781-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An upstream approach to palliative care in the last 12 months of life delivered by primary care practices is often referred to as Primary Palliative Care (PPC). Implementing case management functions can support delivery of PPC and help patients and their families navigate health, social and fiscal environments that become more complex at end-of-life. A realist synthesis was conducted to understand how multi-level contexts affect case management functions related to initiating end-of-life conversations, assessing patient and caregiver needs, and patient/family centred planning in primary care practices to improve outcomes. The synthesis also explored how these functions aligned with critical community resources identified by patients/families dealing with end-of-life. METHODS A realist synthesis is theory driven and iterative, involving the investigation of proposed program theories of how particular contexts catalyze mechanisms (program resources and individual reactions to resources) to generate improved outcomes. To assess whether program theories were supported and plausible, two librarian-assisted and several researcher-initiated purposive searches of the literature were conducted, then extracted data were analyzed and synthesized. To assess relevancy, health system partners and family advisors informed the review process. RESULTS Twenty-eight articles were identified as being relevant and evidence was consolidated into two final program theories: 1) Making end-of-life discussions comfortable, and 2) Creating plans that reflect needs and values. Theories were explored in depth to assess the effect of multi-level contexts on primary care practices implementing tools or frameworks, strategies for improving end-of-life communications, or facilitators that could improve advance care planning by primary care practitioners. CONCLUSIONS Primary care practitioners' use of tools to assess patients/families' needs facilitated discussions and planning for end-of-life issues without specifically discussing death. Also, receiving training on how to better communicate increased practitioner confidence for initiating end-of-life discussions. Practitioner attitudes toward death and prior education or training in end-of-life care affected their ability to initiate end-of-life conversations and plan with patients/families. Recognizing and seizing opportunities when patients are aware of the need to plan for their end-of-life care, such as in contexts when patients experience transitions can increase readiness for end-of-life discussions and planning. Ultimately conversations and planning can improve patients/families' outcomes.
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Affiliation(s)
- Grace Warner
- School of Occupational Therapy, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Lisa Garland Baird
- Faculty of Nursing, University of Prince Edward Island, 550 University Avenue, Charlottetown, PEI, C1A 4P3, Canada
| | - Brendan McCormack
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh, EH21 6UU, Scotland
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Cheryl Tschupruk
- Palliative Care Integration, Nova Scotia Health Authority, 530C Bethune Building, 1276 South Park st, Halifax, NS, Canada
| | - Erin Christian
- Primary Health Care Implementation, Nova Scotia Health Authority, 6960 Mumford Road, Suite 2068, Halifax, NS, B3L 4P1, Canada
| | - Lori Weeks
- School of Nursing, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Kothai Kumanan
- Palliative Care Integration, Nova Scotia Health Authority, Room 522 Bethune Building, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Tara Sampalli
- Research, Innovation and Discovery, Nova Scotia Health Authority, Halifax, Canada
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Rafii F, Taleghani F, Khatooni M. The Process of Pain Management in Cancer Patients at Home: Causing the Least Harm - A Grounded Theory Study. Indian J Palliat Care 2021; 26:457-467. [PMID: 33623306 PMCID: PMC7888409 DOI: 10.4103/ijpc.ijpc_8_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/25/2020] [Indexed: 11/04/2022] Open
Abstract
Background Cancer pain management at home is a complicated and multidimensional experience that affects the foundational aspects of patients and their families' lives. Understanding the pain relief process and the outcomes of palliative care at home is essential for designing programs to improve the quality of life of patients and their families. Objective To explore family caregivers and patients' experiences of pain management at home and develop a substantive theory. Design The study was carried out using a grounded theory methodology. Setting/Participants Twenty patients and 32 family caregivers were recruited from Oncology wards and palliative medicine clinics in the hospitals affiliated to Iran University of Medical Sciences using Purposeful and theoretical sampling. Results The core category in this study was "pain relief with the least harm." Other categories were formed around the core category including "pain assessment, determining the severity of pain, using hierarchical approaches to pain relief, assessing the results of applied approaches, determining the range of effectiveness, and barriers and facilitators of pain relief." The substantive theory emerged from these categories was "Pain management process in cancer patients at home: Causing the least harm" that explains the stages of applying hierarchical approaches to pain relief, family care givers try to make decisions in a way that maximize pain relief and minimize damage to the patient. Along with using a hierarchical pattern, the process is featured with a circular pattern at broader perspective, which reflects dynamism of the process. Conclusion The inferred categories and theory can expand knowledge and awareness about the stages of pain relief process, the pattern of using pain relief approaches, and the barriers and facilitators of pain relief process at home. Health-care professionals may use these findings to assess the knowledge, skill, capability, problems, and needs of family caregivers and patients and develop supportive and educational programs to improve the efficiency of pain relief process at home and improve the patients' quality of life.
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Affiliation(s)
- Forough Rafii
- Nursing Care Research Centre, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Taleghani
- Nursing and Midwifery Care Research Centre, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Khatooni
- Nursing Care Research Centre, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Barriers to Effective Cancer Pain Management in Home Setting: A Qualitative Study. Pain Manag Nurs 2020; 22:531-538. [PMID: 33323346 DOI: 10.1016/j.pmn.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pain is one of the most disturbing and distressing symptoms experienced by cancer patients, and it is the most stressful factor affecting all aspects of patients and their families' lives. Understanding the barriers to effective cancer pain management in home setting is essential for designing programs to improve the quality of the patients and their families' lives. AIM Exploring family caregivers' and cancer patients' experiences of barriers to pain management at home. DESIGN Qualitative exploratory descriptive study. SETTING/PARTICIPANTS Twenty patients and 32 family caregivers were recruited from oncology wards and palliative medicine clinics in hospitals affiliated to Iran University of Medical Sciences. METHOD In-depth interviews were conducted with each participant, and audio-recorded and transcribed interviews were analyzed using thematic analysis. RESULTS Ten major themes emerged regarding barriers to cancer pain management in home setting: "Drug dependence and addiction," "Malingering," "Negative attitudes towards opioid analgesia," "Concealing pain," "Painful comorbidities," "Conflict in family members' perspectives," "Inaccessibility of pain relief facilities," "Poor skill and knowledge," "Patients' feelings of depression and hopelessness," and "Caregiver burden." CONCLUSION The study documented the need for supportive and educational programs for cancer patients and their family caregivers in an attempt to improve the effectiveness of pain managment and cancer patients' quality of life.
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13
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Ware OD, Cagle JG. The Assessment of Pain and Barriers to Pain Management: A Content Analysis From a National Sample of Hospice Psychosocial Assessments Completed by Social Workers. Am J Hosp Palliat Care 2020; 38:260-265. [PMID: 32909816 DOI: 10.1177/1049909120953809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pain is a multidimensional symptom frequently experienced by hospice patients that is physical, psychological, social, emotional, and spiritual. Medicare regulations require hospices to complete a psychosocial assessment with content such as patient/family adjustment to illness. Furthermore, pain barriers such as concerns about addiction, and fatalism are recognized impediments to high quality pain management. National data concerning whether hospice social workers are paying attention to issues related to patient pain is minimal. Addressing this gap, we randomly sampled 248 hospices nationally and requested a blank copy of their social work psychosocial assessment and reviewed its pain-related content. A total of 105 hospices (response rate 42.3%) provided an assessment for review. Descriptive statistics summarize agency characteristics and whether pain assessment content and pain barrier content were present. Analyses examined whether pain assessment content was included based on agency characteristics. Of the 105 participating agencies, most were non-profit (60%) and located in the South (30.5%). Less than half (47.6%) of the agencies included pain assessment content in their assessment. No associations were observed between having pain assessment content and agency characteristics. None of the assessments included content about 3 barriers to pain management: tolerance, overdose, stigma, and fatalism. Few agencies included other barriers to pain management: addiction (1%), burden (1%), non-adherence (3.8%) and stoicism (18.1%). Agencies which had pain assessment content mostly included other dimensions of pain: psychological (80%), emotional (74%), and social (78%). Hospice social workers can do more to assess and address pain concerns-especially psychological, social, and emotional dimensions.
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Affiliation(s)
- Orrin D Ware
- 12265University of Maryland, School of Social Work, MD, USA
| | - John G Cagle
- 12265University of Maryland, School of Social Work, MD, USA
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Chi NC, Barani E, Fu YK, Nakad L, Gilbertson-White S, Herr K, Saeidzadeh S. Interventions to Support Family Caregivers in Pain Management: A Systematic Review. J Pain Symptom Manage 2020; 60:630-656.e31. [PMID: 32339651 PMCID: PMC7483228 DOI: 10.1016/j.jpainsymman.2020.04.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/29/2022]
Abstract
CONTEXT Family caregivers encounter many challenges when managing pain for their loved ones. There is a lack of clear recommendations on how to prepare caregivers in pain management. OBJECTIVES To evaluate existing interventions that support family caregivers in providing pain management to patients with all disease types. METHODS Four electronic databases were systematically searched (PubMed, Cumulative Index for Nursing Allied Health Literature, PsycINFO, and Scopus) using index and keyword methods for articles published before December 2019. The Mixed Methods Appraisal Tool was used to assess the quality. RESULTS The search identified 6851 studies, and 25 studies met the inclusion criteria. Only two studies exclusively focused on noncancer populations (8%). Three types of interventions were identified in this review: educational interventions, cognitive-behavioral interventions, and technology-based interventions. Both educational and cognitive-behavioral interventions improved family caregiver and patient outcomes, but the content and intensity of these interventions in these studies varied widely, and there was a limited number of randomized clinical trials (68%). Hence, it is unclear what strategies are most effective to prepare family caregivers in pain management. Technology-based interventions were feasible to support family caregivers in providing pain management. CONCLUSION Providing adequate pain management training can improve patient and family caregiver outcomes. However, the most effective interventions for family caregivers are still unclear. More rigorous and replicable clinical trials are needed to examine the effects of educational interventions, cognitive-behavioral interventions, and technology-based interventions. Also, more studies are needed in patients with a noncancer diagnosis or multimorbidity.
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Affiliation(s)
- Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, Iowa, USA.
| | - Emelia Barani
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Ying-Kai Fu
- College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Lynn Nakad
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | | | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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15
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LeBaron V, Bennett R, Alam R, Blackhall L, Gordon K, Hayes J, Homdee N, Jones R, Martinez Y, Ogunjirin E, Thomas T, Lach J. Understanding the Experience of Cancer Pain From the Perspective of Patients and Family Caregivers to Inform Design of an In-Home Smart Health System: Multimethod Approach. JMIR Form Res 2020; 4:e20836. [PMID: 32712581 PMCID: PMC7481872 DOI: 10.2196/20836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/11/2020] [Accepted: 07/25/2020] [Indexed: 01/20/2023] Open
Abstract
Background Inadequately managed pain is a serious problem for patients with cancer and those who care for them. Smart health systems can help with remote symptom monitoring and management, but they must be designed with meaningful end-user input. Objective This study aims to understand the experience of managing cancer pain at home from the perspective of both patients and family caregivers to inform design of the Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C) smart health system. Methods This was a descriptive pilot study using a multimethod approach. Dyads of patients with cancer and difficult pain and their primary family caregivers were recruited from an outpatient oncology clinic. The participant interviews consisted of (1) open-ended questions to explore the overall experience of cancer pain at home, (2) ranking of variables on a Likert-type scale (0, no impact; 5, most impact) that may influence cancer pain at home, and (3) feedback regarding BESI-C system prototypes. Qualitative data were analyzed using a descriptive approach to identity patterns and key themes. Quantitative data were analyzed using SPSS; basic descriptive statistics and independent sample t tests were run. Results Our sample (n=22; 10 patient-caregiver dyads and 2 patients) uniformly described the experience of managing cancer pain at home as stressful and difficult. Key themes included (1) unpredictability of pain episodes; (2) impact of pain on daily life, especially the negative impact on sleep, activity, and social interactions; and (3) concerns regarding medications. Overall, taking pain medication was rated as the category with the highest impact on a patient’s pain (=4.79), followed by the categories of wellness (=3.60; sleep quality and quantity, physical activity, mood and oral intake) and interaction (=2.69; busyness of home, social or interpersonal interactions, physical closeness or proximity to others, and emotional closeness and connection to others). The category related to environmental factors (temperature, humidity, noise, and light) was rated with the lowest overall impact (=2.51). Patients and family caregivers expressed receptivity to the concept of BESI-C and reported a preference for using a wearable sensor (smart watch) to capture data related to the abrupt onset of difficult cancer pain. Conclusions Smart health systems to support cancer pain management should (1) account for the experience of both the patient and the caregiver, (2) prioritize passive monitoring of physiological and environmental variables to reduce burden, and (3) include functionality that can monitor and track medication intake and efficacy; wellness variables, such as sleep quality and quantity, physical activity, mood, and oral intake; and levels of social interaction and engagement. Systems must consider privacy and data sharing concerns and incorporate feasible strategies to capture and characterize rapid-onset symptoms.
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Affiliation(s)
- Virginia LeBaron
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Rachel Bennett
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Ridwan Alam
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Leslie Blackhall
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Kate Gordon
- Virginia Commonwealth University Health, Richmond, VA, United States
| | - James Hayes
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Nutta Homdee
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Randy Jones
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - Yudel Martinez
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Emmanuel Ogunjirin
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA, United States
| | - Tanya Thomas
- University of Virginia School of Nursing, Charlottesville, VA, United States
| | - John Lach
- The George Washington University School of Engineering & Applied Science, Washington, DC, United States
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16
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Wilson E, Caswell G, Latif A, Anderson C, Faull C, Pollock K. An exploration of the experiences of professionals supporting patients approaching the end of life in medicines management at home. A qualitative study. BMC Palliat Care 2020; 19:66. [PMID: 32393231 PMCID: PMC7216477 DOI: 10.1186/s12904-020-0537-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/03/2020] [Indexed: 12/01/2022] Open
Abstract
Background The management of medicines towards the end of life can place increasing burdens and responsibilities on patients and families. This has received little attention yet it can be a source of great difficulty and distress patients and families. Dose administration aids can be useful for some patients but there is no evidence for their wide spread use or the implications for their use as patients become increasing unwell. The study aimed to explore how healthcare professionals describe the support they provide for patients to manage medications at home at end of life. Methods Qualitative interview study with thematic analysis. Participants were a purposive sample of 40 community healthcare professionals (including GPs, pharmacists, and specialist palliative care and community nurses) from across two English counties. Results Healthcare professionals reported a variety of ways in which they tried to support patients to take medications as prescribed. While the paper presents some solutions and strategies reported by professional respondents it was clear from both professional and patient/family caregiver accounts in the wider study that rather few professionals provided this kind of support. Standard solutions offered included: rationalising the number of medications; providing different formulations; explaining what medications were for and how best to take them. Dose administration aids were also regularly provided, and while useful for some, they posed a number of practical difficulties for palliative care. More challenging circumstances such as substance misuse and memory loss required more innovative strategies such as supporting ways to record medication taking; balancing restricted access to controlled drugs and appropriate pain management and supporting patient choice in medication use. Conclusions The burdens and responsibilities of managing medicines at home for patients approaching the end of life has not been widely recognised or understood. This paper considers some of the strategies reported by professionals in the study, and points to the great potential for a more widely proactive stance in supporting patients and family carers to understand and take their medicines effectively. By adopting tailored, and sometimes, ‘outside the box’ thinking professionals can identify immediate, simple solutions to the problems patients and families experience with managing medicines.
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Affiliation(s)
- Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK. .,Nottingham Centre for the Advancement of Research in End of life care (NCARE), B302 School of Health Sciences, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire Anderson
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | | | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
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17
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Cancer Pain Social Processes and Pain Management in Home Hospice Care. Pain Manag Nurs 2019; 20:541-548. [DOI: 10.1016/j.pmn.2019.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/21/2019] [Accepted: 06/18/2019] [Indexed: 01/08/2023]
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18
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Kizza IB, Muliira JK. The Influence of a Home-Based Education Intervention on Family Caregivers' Knowledge and Self-Efficacy for Cancer Pain Management in Adult Patients Within a Resource-Limited Setting. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:1150-1159. [PMID: 30187440 DOI: 10.1007/s13187-018-1421-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cancer-related pain is prevalent and has debilitating effects on patients and their family. The effects of cancer pain can be curtailed if the family members caring for the patient receive essential support to enhance their capabilities for cancer pain management. Little has been done to study the available support to family caregivers (FCGs) towards pain management in adult cancer patients (ACPs) living in resource-limited countries where the burden of cancer is on the rise. This study evaluated the influence of an education intervention delivered in the home setting on FCGs' knowledge and self-efficacy (SE) for pain management in ACPs. One-group pre-/post-test design was used in a sample of 54 FCGs who had been caring for ACPs suffering from pain for at least 1 month. Data were collected using the Family Pain Questionnaire and Caregiver Pain Management SE Scale. The FCGs' mean knowledge score post-intervention (26.69 ± 10) was higher than the baseline (45 ± 12.9), and the difference was statistically significant (t = 10.382, p = 0.000, CI = 17.12-25.43). Additionally, the FCGs' mean SE score post-intervention (1003.30 ± 191) was higher than the baseline (648.3 ± 273.4), and the difference was statistically significant (t = - 8.52, p = 0.000, CI = - 438.6-- 271.4). The home-based education intervention significantly and positively influenced the FCGs' knowledge and SE for pain management while at home. Cancer pain management educational interventions delivered at home should be considered as one of the strategies for enhancing cancer care in resource limited settings.
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Affiliation(s)
- Irene Betty Kizza
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, P. O. Box 66, Al Khod, Muscat, Oman.
| | - Joshua Kanaabi Muliira
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, P. O. Box 66, Al Khod, Muscat, Oman
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Washington KT, Oliver DP, Smith JB, Kruse RL, Meghani SH, Demiris G. A Comparison of Rural and Urban Hospice Family Caregivers' Cancer Pain Knowledge and Experience. J Pain Symptom Manage 2019; 58:685-689. [PMID: 31325546 PMCID: PMC6754759 DOI: 10.1016/j.jpainsymman.2019.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Family caregivers play a vital role in managing the pain of hospice patients with cancer; however, caregivers' knowledge of pain management principles and experiences as pain managers vary widely. Differences in cultural values and access to resources suggest that rural and urban hospice family caregivers may differ with regard to their pain knowledge and experience, but this has not been empirically investigated. OBJECTIVES We sought to determine if rural and urban hospice family caregivers differed in terms of their knowledge of cancer pain management principles and their experiences managing cancer pain. METHODS Our study consisted of a secondary analysis of baseline, cross-sectional data from hospice family caregivers (N = 196) participating in an ongoing cluster randomized crossover pragmatic trial. We performed multivariable regression to model associations between caregivers' demographic characteristics and their scores on the Family Pain Questionnaire (FPQ), which included subscales measuring pain knowledge and experience. RESULTS When controlling for other demographic variables, rural caregivers' scores on the FPQ knowledge subscale were worse (P = 0.01) than their urban counterparts. FPQ experience subscale scores and FPQ total scores were not statistically significantly different between the two groups. CONCLUSION Rural hospice family caregivers report greater pain knowledge deficits than urban hospice family caregivers, although the two groups report comparable pain management experiences. Additional research is needed to better explain observed differences.
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Affiliation(s)
- Karla T Washington
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA.
| | - Debra Parker Oliver
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jamie B Smith
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Salimah H Meghani
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Demiris
- Schools of Nursing and Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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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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21
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Family caregivers for adult cancer patients: knowledge and self-efficacy for pain management in a resource-limited setting. Support Care Cancer 2018; 27:2265-2274. [PMID: 30327878 DOI: 10.1007/s00520-018-4504-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
Adult cancer patients (ACPs) in resource-limited settings disproportionately suffer from inadequate pain control despite advancements in pain management. Family caregivers (FCGs) can support optimal pain control for ACPs in these settings if they are knowledgeable and confident about the needed care. However, the status of FCGs' knowledge and self-efficacy (SE) for pain management in developing countries is not well established. PURPOSE To assess the FCGs' knowledge and SE levels for pain management among ACPs while at home in a resource-limited setting. METHODS Using a questionnaire that comprised a Family Pain Questionnaire and Chronic Pain Self-efficacy Scale, data were collected from 284 FCGs of ACPs receiving care from two cancer care centres. RESULTS The FCGs had moderate knowledge (mean = 41.70 ± 14.1) and SE (mean = 795.95 ± 301.3) levels for pain management at home for ACPs. Majority of the FCGs had low knowledge (52.1%), but expressed higher SE (52.5%). Poor self-rated health among FCGs was significantly associated with low knowledge levels (OR = 1.75; 95% CI 1.024-2.978, p = 0.041). SE was significantly associated with perceiving a low impact of caregiving on health (OR = 1.55; 95% CI 1.074-2.239, p = 0.019), hours of caregiving per week (OR = 0.52; 95% CI 0.315-0.854; p = 0.01) and receiving organisational support (OR = 0.388; 95% CI 0.222-0.679; p = 0.001). CONCLUSION The results show a need for deliberate interventions to enhance FCG knowledge and SE for pain management at home as one of the ways of improving cancer pain management in resource-limited settings.
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22
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Chi NC, Han S, Barani E, Parker Oliver D, Washington KT, Lewis FM, Walker A, Demiris G. Development and Preliminary Evaluation of a Pain Management Manual for Hospice Providers to Support and Educate Family Caregivers. Am J Hosp Palliat Care 2018; 36:207-215. [PMID: 30304938 DOI: 10.1177/1049909118804984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Family caregivers encounter many barriers to managing patients' pain in the home hospice setting. However, there are limited clinically applicable resources for hospice providers to help family caregivers identify and address these barriers. AIM To develop a pain management manual for hospice providers to support family caregivers and conduct a preliminary providers' evaluation of the manual. DESIGN AND PARTICIPANTS A pain management manual was developed and structured into 3 parts: (1) 5 common pain management case scenarios based on a secondary data analysis of a hospice clinical trial; (2) a list of suggested assessment questions and strategies for each case scenario was developed based on a caregiver framework; and (3) pain educational material was included from established clinical guidelines. The manual was vetted by 5 experts and then was evaluated by interviewing 25 hospice providers. Interview data were analyzed using thematic analysis. RESULTS The hospice providers found that the manual could potentially serve as a reference in their practice and be a source for their continuing education. They suggested enhancing the clarity of the case scenarios and adding additional strategies to the manual. Moreover, they suggested expanding the paper-based version and developing a web-based platform to deliver the content would maximize its utility. CONCLUSIONS The manual has the potential to be integrated into routine hospice care to improve the quality of pain management.
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Affiliation(s)
- Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Soojeong Han
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Emelia Barani
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Debra Parker Oliver
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Karla T Washington
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Frances Marcus Lewis
- Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA.,Public Health and Clinical Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Amy Walker
- Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Lessons From an Immersion Experience in Southern India. J Hosp Palliat Nurs 2018; 20:500-505. [PMID: 30188445 DOI: 10.1097/njh.0000000000000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately 2.4 million people in India are living with cancer, and more than 1 million new cancer diagnoses are made annually, often in advanced stages of disease. An estimated 80% of patients with advanced cancer will develop significant pain resulting in the need to increase access to appropriate palliative care services across the country, including a priority on pain and symptom management. This article describes the history and status of palliative care across India, with an emphasis on the efforts made in the southern state of Kerala to engage community volunteers in the care of patients with chronic serious illness. Lessons learned from a palliative care nurse fellow's 2-week immersion in southern India are shared.
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Washington KT, Wilkes CM, Rakes CR, Otten SJ, Parker Oliver D, Demiris G. Relationships among Symptom Management Burden, Coping Responses, and Caregiver Psychological Distress at End of Life. J Palliat Med 2018; 21:1234-1241. [PMID: 29727256 DOI: 10.1089/jpm.2017.0584] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Family caregivers (FCGs) face numerous stressors and are at heightened risk of psychological distress. While theoretical explanations exist linking caregiving stressors with outcomes such as anxiety and depression, limited testing of these theories has occurred among FCGs of patients nearing the end of life. OBJECTIVE Researchers sought to evaluate mediational relationships among burden experienced by hospice FCGs because of symptom management demands, caregivers' coping responses, and caregivers' psychological distress. DESIGN Quantitative data for this descriptive exploratory study were collected through survey. Hypothesized relationships among caregiver variables were examined with structural equation modeling. SETTING/SUBJECTS Respondents were FCGs (N = 228) of hospice patients receiving services from a large, non-profit community hospice in the Mid-Southern United States. RESULTS Burden associated with managing hospice patients' psychological symptoms was shown to predict psychological distress for FCGs. Caregivers' use of escape-avoidance coping responses mediated this relationship. CONCLUSIONS Results suggest that FCGs would benefit from additional tools to address patients' psychological symptoms at end of life. When faced with psychological symptom management burden, caregivers need a range of coping skills as alternatives to escape-avoidance coping.
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Affiliation(s)
- Karla T Washington
- 1 Department of Family and Community Medicine, University of Missouri , Columbia, Missouri
| | - Chelsey M Wilkes
- 2 College of Health Professions, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois.,3 Louis Stokes Cleveland Veterans Affairs Medical Center , Cleveland, Ohio
| | - Christopher R Rakes
- 4 Department of Education, University of Maryland , Baltimore County, Baltimore, Maryland
| | | | - Debra Parker Oliver
- 1 Department of Family and Community Medicine, University of Missouri , Columbia, Missouri
| | - George Demiris
- 6 School of Nursing and Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
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Han CJ, Chi NC, Han S, Demiris G, Parker-Oliver D, Washington K, Clayton MF, Reblin M, Ellington L. Communicating Caregivers' Challenges With Cancer Pain Management: An Analysis of Home Hospice Visits. J Pain Symptom Manage 2018; 55:1296-1303. [PMID: 29360571 PMCID: PMC5899943 DOI: 10.1016/j.jpainsymman.2018.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/04/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
CONTEXT Family caregivers (FCGs) of hospice cancer patients face significant challenges related to pain management. Addressing many of these challenges requires effective communication between FCGs and hospice nurses, yet little empirical evidence exists on the nature of communication about pain management between hospice nurses and FCGs. OBJECTIVES We identified ways in which FCGs of hospice cancer patients communicated their pain management challenges to nurses during home visits and explored nurses' responses when pain management concerns were raised. METHODS Using secondary data from audio recordings of hospice nurses' home visits, a deductive content analysis was conducted. We coded caregivers' pain management challenges and immediate nurses' responses to these challenges. RESULTS From 63 hospice nurse visits, 101 statements describing caregivers' pain management challenges were identified. Thirty percent of these statements pertained to communication and teamwork issues. Twenty-seven percent concerned caregivers' medication skills and knowledge. In 52% of the cases, nurses responded to caregivers' pain management challenges with a validating statement. They provided information in 42% of the cases. Nurses did not address 14% of the statements made by caregivers reflecting pain management challenges. CONCLUSION To optimize hospice patients' comfort and reduce caregivers' anxiety and burden related to pain management, hospice nurses need to assess and address caregivers' pain management challenges during home visits. Communication and educational tools designed to reduce caregivers' barriers to pain management would likely improve clinical practice and both patient- and caregiver-related outcomes.
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Affiliation(s)
- Claire J Han
- Biobehavioral Cancer Prevention and Control Training Program, University of Washington, School of Public Health, Seattle, Washington, USA.
| | - Nai-Ching Chi
- University of Iowa, College of Nursing, Iowa City, Iowa, USA
| | - Soojeong Han
- University of Washington, School of Nursing, Seattle, Washington, USA
| | - George Demiris
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, USA
| | - Debra Parker-Oliver
- University of Missouri, School of Medicine, Family and Community Medicine, Columbia, Missouri, USA
| | - Karla Washington
- University of Missouri, School of Medicine, Family and Community Medicine, Columbia, Missouri, USA
| | | | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Lee Ellington
- University of Utah, College of Nursing, Salt Lake City, Utah, USA
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Chi NC, Demiris G, Pike KC, Washington K, Oliver DP. Pain Management Concerns From the Hospice Family Caregivers' Perspective. Am J Hosp Palliat Care 2017; 35:601-611. [PMID: 28875732 DOI: 10.1177/1049909117729477] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pain management is a challenging task for family caregivers in home hospice care. However, there are limited studies that examine the challenges regarding pain management in hospice care from family caregivers' perspectives. OBJECTIVES To identify the challenges related to pain management faced by family caregivers in hospice care and to examine the validity of an existing framework that outlines pain management challenges for hospice family caregivers. DESIGN We conducted a theory-driven, deductive content analysis of secondary data obtained from hospice family caregivers' interviews from a randomized clinical trial. SETTING/PARTICIPANTS We included baseline interviews of 15 hospice caregivers of patients from hospice agencies in the States of Washington. The majority of the participants were white and female caregivers. They were spouse/partner or adult child living with the patient. RESULTS The study identified 5 out of the 6 major themes in the original framework and confirmed that hospice family caregivers face a variety of challenges: caregiver-centric issues, caregiver's medication skills and knowledge, communication and teamwork, organizational skill, and patient-centric issues. A couple of the subthemes in the original framework were not present in our findings. We also expanded the original framework by adding 1 subtheme and revised 2 definitions in the original framework. CONCLUSION The study provided an investigation on hospice family caregivers' difficulties in pain management. The results can inform health-care providers and researchers of family caregivers' challenges and provide insights for future designs of educational tools targeting pain management strategies, so that family caregivers can perform pain management effectively at home.
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Affiliation(s)
- Nai-Ching Chi
- 1 College of Nursing, University of Iowa, Iowa City, IA, USA
| | - George Demiris
- 2 Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA.,3 Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kenneth C Pike
- 4 Department of Psychosocial and Community Health, School of Nursing, Universality of Washington, Seattle, WA, USA
| | - Karla Washington
- 5 Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Debra Parker Oliver
- 5 Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
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Mayahara M, Wilbur J, O'Mahony S, Breitenstein S. E-Pain Reporter: A Digital Pain and Analgesic Diary for Home Hospice Care. J Palliat Care 2017; 32:77-84. [PMID: 28868960 DOI: 10.1177/0825859717722466] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Informal hospice caregivers play a key role in managing patients' pain at home, but lack of adherence to doctor-prescribed analgesic regimens and medication errors are significant barriers to truly effective pain management. A digital pain diary may improve caregiver management of pain at home; however, most digital pain tools available today were developed without input from patients or caregivers. Accordingly, the purpose of this study was to develop a digital pain application (1) for hospice caregivers to record patient pain and analgesic use and (2) for nurses to monitor administration of analgesics by caregivers. Using advisory group methods, nurse case managers (n = 6), and informal caregivers (n = 3) helped us to convert a paper-based pain and analgesic diary into a digital format-the e-PAIN Reporter-and to refine the application. The e-PAIN Reporter provides information on patient pain assessment and pain management and reports to nurses in real time. Further testing is now needed to determine (1) the feasibility of using the e-PAIN Reporter and (2) its effectiveness in improving pain management for hospice patients.
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Affiliation(s)
- Masako Mayahara
- 1 College of Nursing, Rush University, Chicago, Illinois, USA
| | - JoEllen Wilbur
- 1 College of Nursing, Rush University, Chicago, Illinois, USA
| | - Sean O'Mahony
- 1 College of Nursing, Rush University, Chicago, Illinois, USA.,2 Rush Medical College, Rush University, Chicago, Illinois, USA.,3 Palliative Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Miller LE, Eldredge SA, Dalton ED. “Pain Is What the Patient Says It Is”: Nurse–Patient Communication, Information Seeking, and Pain Management. Am J Hosp Palliat Care 2016; 34:966-976. [DOI: 10.1177/1049909116661815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Nurse–patient conversations about pain management are complex. Given recent increases in prescription pain pill abuse, such interactions merit scholarly attention. In-depth interviews with 21 nurses were conducted to explicitly explore nurses’ information seeking about pain. The participants in this study gathered pain information from patients through a variety of means and reported facing challenges and dilemmas when communicating with patients about pain management and medicinal preferences. These results have important implications for nurses, patient outcomes, and the broader health-care system and imply that continued educational and intervention efforts are essential in this complicated communicative context.
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Affiliation(s)
- Laura E. Miller
- School of Communication Studies, University of Tennessee, Knoxville, TN, USA
| | - Scott A. Eldredge
- Department of Communication, Western Carolina University, Cullowhee, NC, USA
| | - Elizabeth D. Dalton
- Department of Communication Studies and Organizational Communication, Middle Tennessee State University, Murfreesboro, TN, USA
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Tarter R, Demiris G, Pike K, Washington K, Parker Oliver D. Pain in Hospice Patients With Dementia: The Informal Caregiver Experience. Am J Alzheimers Dis Other Demen 2016; 31:524-9. [PMID: 27303062 DOI: 10.1177/1533317516653825] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION At the end of life, patients with dementia often experience high levels of pain due to complex interplay of disease processes and numerous barriers to symptom management. In the hospice setting, informal caregivers play an essential role in pain management. This study describes their experience managing pain in hospice patients with dementia. METHODS We conducted a qualitative analysis of audio-recorded interviews with informal caregivers of hospice patients with dementia who had chosen pain as the challenge they wanted to work on within a problem-solving therapy intervention. RESULTS The thematic analysis of sessions with 51 caregivers identified 4 themes: difficulty in communicating with patients, lack of consistent guidance from health-care professionals, perceived uncertainty about the etiology of pain, and secondary suffering. DISCUSSION Our findings indicate the possible need for increased support for caregivers, including educational interventions targeting pain etiology and assessment, and improved communication with health-care professionals.
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Affiliation(s)
- Robin Tarter
- School of Nursing, University of Washington, Seattle, WA, USA
| | - George Demiris
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Kenneth Pike
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Karla Washington
- Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Debra Parker Oliver
- Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
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Latter S, Hopkinson JB, Richardson A, Hughes JA, Lowson E, Edwards D. How can we help family carers manage pain medicines for patients with advanced cancer? A systematic review of intervention studies. BMJ Support Palliat Care 2016; 6:263-75. [PMID: 27150294 PMCID: PMC5013162 DOI: 10.1136/bmjspcare-2015-000958] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 01/18/2016] [Indexed: 12/03/2022]
Abstract
Background Family carers play a significant role in managing pain and associated medicines for people with advanced cancer. Research indicates that carers often feel inadequately prepared for the tasks involved, which may impact on carers’ and patients’ emotional state as well as the achievement of optimal pain control. However, little is known about effective methods of supporting family carers with cancer pain medicines. Aims To systematically identify and review studies of interventions to help carers manage medicines for pain in advanced cancer. To identify implications for practice and research. Method A systematic literature search of databases (MEDLINE, CINAHL, PsycINFO and AMED) was carried out to identify studies of pain medication management interventions that involved family carers of patients with advanced cancer, and reported specific outcomes for family carers. Patient pain outcomes were also sought. Studies were quality appraised; key aspects of study design, interventions and outcomes were compared and a narrative synthesis of findings developed. Results 8 studies were included; all had significant methodological limitations. The majority reported improvements in family carer knowledge and/or self-efficacy for managing pain medicines; no effect on patient pain outcomes; and no adverse effects. It was not possible to discern any association between particular intervention characteristics and family carer outcomes. Conclusions Current evidence is limited, but overall suggests face-to-face educational interventions supported by written and/or other resources have potential to improve carers’ knowledge and self-efficacy for pain management. Further research is needed to identify how best to help family carers manage pain medicines for patients with advanced cancer.
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Affiliation(s)
- Sue Latter
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jane B Hopkinson
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK Department of Cancer Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jane A Hughes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Elizabeth Lowson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Deborah Edwards
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK
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Chi NC, Demiris G. Family Caregivers' Pain Management in End-of-Life Care: A Systematic Review. Am J Hosp Palliat Care 2016; 34:470-485. [PMID: 26975303 DOI: 10.1177/1049909116637359] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Pain management was the most identified burden faced by family caregivers in end-of-life caregiving. OBJECTIVES To synthesize current scientific evidence on family caregivers' experience of pain management in end-of-life care. METHODS A systematic review was conducted using CINAHL, Embase, PubMed, and Cochrane Library electronic databases. Data were extracted from each included paper and organized into tables to synthesize the findings. RESULTS Fourteen research papers focusing on family caregivers' experience of pain management and strategies in end-of-life care were included. Nine were observational studies, 3 were case studies, and 2 were experimental studies. These studies mainly focused on exploring family caregivers' engagement in pain management and communication with the hospice care team about pain control; family caregivers' knowledge, skills, and self-efficacy in pain management; and family caregivers' concerns and experience of pain management. CONCLUSION This review identified themes similar to previous reviews on family caregivers of patients with cancer or in palliative care: inadequate knowledge and assessment skills in pain management, misunderstanding of pain medications, and poor communication with the care team. Future research should design educational programs and material for family caregivers to improve their pain management knowledge and skills, communication, and engagement in care. The scientific knowledge on this topic is scarce, and level of evidence is low; it is therefore imperative to have more exploratory studies to expand the quality and quantity of evidence and increase our understanding of family caregivers' needs and barriers to pain management based on larger and more diverse patient and caregiver samples.
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Affiliation(s)
- Nai-Ching Chi
- 1 School of Nursing, University of Washington, Seattle, WA, USA
| | - George Demiris
- 1 School of Nursing, University of Washington, Seattle, WA, USA.,2 School of Medicine, University of Washington, Seattle, WA, USA
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Lee BO, Liu Y, Wang YH, Hsu HT, Chen CL, Chou PL, Hsu WC. Mediating Effect of Family Caregivers' Hesitancy to Use Analgesics on Homecare Cancer Patients' Analgesic Adherence. J Pain Symptom Manage 2015; 50:814-21. [PMID: 26297852 DOI: 10.1016/j.jpainsymman.2015.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/19/2015] [Accepted: 07/06/2015] [Indexed: 02/08/2023]
Abstract
CONTEXT Family caregivers play an increasingly critical role in cancer patients' symptom management as the number of cancer patients receiving home care grows. However, there is a lack of research measuring the impact of the family caregivers' hesitancy to use analgesics on analgesic adherence and the resulting influence on patient pain intensity. OBJECTIVES To examine whether family caregivers' hesitancy to use analgesics is a mediator that influences patient adherence and investigate how analgesic regimen adherence affects pain intensity. METHODS This study used a cross-sectional and descriptive design. One hundred seventy-six patient-family caregiver dyads (N = 352) were recruited from one local hospital in southern Taiwan. Instruments included the Short Version of the Barriers Questionnaire-Taiwan, the Morisky Medication Adherence Measure-Taiwan, the Brief Pain Inventory-Chinese, and demographic and illness questionnaires. A one-way analysis of variance and post hoc comparisons were performed to assess the influence of analgesic regimen adherence on pain intensity. Sobel tests were used to examine mediating effects. RESULTS Family caregivers' hesitancy to use analgesics was a significant mediator between patient barriers to use analgesics and patient analgesic regimen adherence (P < 0.0001). Patients with low and moderate adherence levels reported significantly higher levels of pain severity (F = 3.83, P < 0.05). CONCLUSION This study showed that family caregivers' hesitancy to use analgesics was a significant mediator associated with their hesitancy to use analgesics and the patients' analgesic adherence. It is important for health care providers to consider family caregivers' hesitancy to use analgesics when attempting to improve adherence to pain management regimens in clinical practice.
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Affiliation(s)
- Bih-O Lee
- Department of Nursing, Chang Gung University of Science and Technology, Chia-Yi Campus, Taiwan, Republic of China
| | - Yi Liu
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Yi-Hsien Wang
- Research Center for Nonlinear Analysis & Optimization, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Hsin-Tien Hsu
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Chien-Liang Chen
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan, Republic of China
| | - Pi-Ling Chou
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
| | - Wen-Chung Hsu
- Institute of Human Resource Management, National Sun Yat-sen University, Kaohsiung, Taiwan, Republic of China
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Kao YH, Chiang JK. Effect of hospice care on quality indicators of end-of-life care among patients with liver cancer: a national longitudinal population-based study in Taiwan 2000-2011. BMC Palliat Care 2015; 14:39. [PMID: 26286505 PMCID: PMC4545784 DOI: 10.1186/s12904-015-0036-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality of near end-of-life (EOL) care is typically evaluated using six accepted quality indicators (QIs). Research has yet to evaluate the quality of EOL care for liver cancer patients in Taiwan. We evaluated the effect of hospice care on the quality of EOL care for patients with advanced liver cancer. METHODS Using claims data obtained from the Taiwan National Health Insurance Research Database, we analyzed the QIs of EOL care for patients who died between 2000 and 2011. Logistic regression was performed to identify predictors for QIs of EOL care. RESULTS A total of 3092 adult patients died of liver cancer during the study period. The patients were divided into those who received hospice care for a period longer than 1 month (long-H group), shorter than 1 month (short-H group), and not at all (non-H group). There was no significant difference in survival probability among the three groups (p = 0.212). Compared with the non-H group, the long- and short-H groups exhibited a significantly lower risk of being admitted to an intensive care unit (ICU) (odds ratios [ORs] = 0.25 and 0.26, respectively, p < 0.001) and requiring cardiopulmonary resuscitation (CPR) during the final month of life (ORs = 0.21 and 0.09, respectively, p < 0.001). Compared with the non-H group, the short-H group had a higher risk of more than one emergency room (ER) visit, and more than one hospital admission (OR = 1.97, p = 0.003; and OR = 1.56, p = 0.001, respectively), but the long-H group did not differed significantly from the non-H group on these measures. CONCLUSIONS Patients with liver cancer who received hospice care were less likely to be admitted to ICUs or require CPR compared with those who received no hospice care. A longer duration of hospice care was associated with reduced risks of more than one ER visit and more than one hospital admission. We conclude that EOL cancer care in Taiwan might be improved by implementing policies encouraging early hospice referral programs.
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Affiliation(s)
- Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital, Tainan, Taiwan.
| | - Jui-Kun Chiang
- Department of Family Medicine, Buddhist Dalin Tzu Chi Hospital, 2 Minsheng Road, Dalin, Chiayi, Taiwan.
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