Factors influencing family caregivers in managing medications for home hospice patients: A conceptual framework

OBJECTIVE: Medication management for elderly patients receiving hospice care at home is an important and complex responsibility for family caregivers. This qualitative study explores family caregivers' experiences helping hospice patients with their medications and describes a framework for conceptualizing perceived factors that influence medication management at home. METHODS: Qualitative interviews were conducted with 22 hospice providers and 23 family caregivers from 4 hospice programs in the Chicagoland area. Emergent themes were analyzed according to the principles of grounded theory. RESULTS: Based on the perspectives of professional and family caregivers, we identified two types of caregivers' responsibility in medication management: technical (administering medications and monitoring the patient) and management (organizing medications and coordinating with other caregivers). Fulfilling medication responsibilities was closely linked to the development of caregivers' knowledge/attitude/skills and self-efficacy in medication management over time. Four factors influenced medication management at home: 1) caregiving context (patient's needs and demands, and medication complexity); 2) hospice services (education/resources, direct care, and emotional support); 3) caregiver's characteristics (life experience, psycho-emotional state, physical/cognitive health, and other competing obligations); and 4) other informal or privately-hired caregivers' characteristics (knowledge/attitude about hospice treatments). Furthermore, caregivers' relationship with the patient, hospice team, or other informal and privately-hired caregivers modified the influence of these four factors on the medication management process. CONCLUSION: The proposed conceptual framework will help guide future development of clinical interventions to improve medication management for family caregivers of home hospice patients.