222207 Hospice providers' reported practices in helping informal caregivers manage medications for home hospice patients

Monday, November 8, 2010 : 9:00 AM - 9:15 AM

Denys T. Lau, PhD , Department of Pharmacy Administration, University of Illinois at Chicago, Chicago, IL
Brian Joyce, BA , Division of Epidemiology and Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, IL
Marla L. Clayman, PhD, MPH , Robert H. Lurie Comprehensive Cancer Center of Northwestern University &, Division of General Internal Medicine, Northwestern University, Chicago, IL
Sydney Dy, MD , Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
Linda Ehrlich-Jones, PhD, RN , Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
Linda E. Emanuel, MD, PhD , Buehler Center on Aging, Northwestern University, Chicago, IL
Joshua Hauser, MD , Buehler Center on Aging, Health & Science, Northwestern University, Chicago, IL
Judith Paice, PhD, RN , Division of Hematology-Oncology, Northwestern University, Chicago, IL
Joseph Shega, MD , Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL
OBJECTIVES: Informal caregivers such as family and friends provide most of the hands-on care, including medication and symptom management, for patients receiving end-of-life care at home. Many caregivers identify hospice providers as their primary source of information and support regarding medication management. This qualitative study explores the current practices used by hospice providers to help caregivers manage medications for home hospice patients. METHODS: Semi-structured, open-ended interviews were conducted with 22 providers (14 nurses, 4 physicians, and 4 social workers) from 4 Chicago-based hospice organizations. RESULTS: Nurses emphasized different educational methods used to teach caregivers about medication management and various approaches employed to evaluate and empower caregivers from observing behaviors to providing positive feedback. Social workers focused on building rapport with caregivers especially during hospice enrollment, addressing interpersonal conflicts among caregivers and patients, and mobilizing supportive resources for extra help. Physicians discussed simplifying medication regimens to assist caregivers and assessing patient health status as a means of evaluating caregivers' performance in managing medications. Collectively, we identified five domains that constituted how hospice providers helped caregivers manage medications: 1) rapport (established trust, assessed the care situation); 2) education (instructed, demonstrated); 3) empowerment (offered feedback, encouraged caregiver); 4) evaluation (observed caregiver behaviors, assessed patient status); and 5) extra professional help (provided direct assistance, acquired resources). CONCLUSION: Supporting informal caregivers in managing medications is a multi-dimensional task that requires a concerted effort from hospice nurses, physicians and social workers. Future research should investigate how common, standardized, and effective these techniques are in practice.

Learning Areas:
Public health or related education
Public health or related nursing

Learning Objectives:
1) Describe hospice practices used to help informal caregivers manage medications for patients receiving end-of-life care at home. 2) Identify the roles of hospice nurses, physicians and social workers in assisting informal caregivers with medication management for home hospice patients.

Keywords: End-of-Life Care, Caregivers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract Author on the content I am responsible for because I am the P.I. of the NIA KO1 grant award that funded this project being prsented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3031.0: End of Life Care/Issues