Family caregiver competence in medication management for home hospice patients: A literature review

OBJECTIVE: Elderly patients receiving hospice care at home greatly depend on their family members to assume the complex responsibility of medication management. As an initial step toward developing a conceptual model that defines competence in medication management and describes how it is related to performance and outcomes, this study examines the theoretical and empirical literature on family responsibilities in medication management, especially those relevant to seriously-ill elderly patients. METHODS: Three content areas were reviewed: family caregiving skills and capacity, medication management, and pain and symptom management among seriously-ill patients. Relevant studies were identified by searching online databases: MEDLINE, PsychINFO, and Ageline. Theoretical and empirical articles published in English were included. RESULTS: Among 58 relevant articles, 31 were about family responsibilities in medication management and 38 were about how competence is related to performance and outcomes. Performing medication-related tasks requires a defined set of physical skills, a high level of cognitive processing, and prerequisite knowledge of diseases, medications, and the patient. Integrating the work from prior studies, a conceptual model is proposed to describe the relationships among competence in medication management, performance, and health-related outcomes related to family caregivers and hospice patients. Intervening variables such as caregiving context, quality of family-patient relationship, and hospice service support are included. CONCLUSION: Having a well-defined conceptual model is useful for developing and targeting comprehensive effective interventions to improve medication management competence among family caregivers of home hospice patients. The proposed model informs future empirical studies that will refine and validate the work presented here.