Development of a Measure of Informal Caregiving Skills in Effective Medication Management for Hospice Patients (CG-SEMM): Interim Results

OBJECTIVE: Managing medications for home hospice elderly patients is an important and complex responsibility for informal (unpaid) caregivers. This study reports the interim results on the development of a new instrument to measure informal caregiving skills in effective medication management (CG-SEMM) for hospice patients. METHODS: Interim results are based on 60 informal caregivers with medication responsibilities from 5 hospice agencies in Chicagoland. The piloted CG-SEMM instrument contains 52 objectively-measured skill items hypothesized to capture 5 conceptual domains: teamwork, organization, medications, symptoms, and personhood. Additionally, 5 self-rated skill items, one corresponding to each domain, were assessed. To examine the structure of each domain, principal components analysis, exploratory factor analyses, internal consistency, and item response theory were examined. RESULTS: The 5 self-rated skill items appear to function as a unidimensional scale that measures caregiver self-efficacy in managing medications (factor loadings=0.55-0.84; alpha=0.84). Among the 52 objectively-measured skill items, there appears to be one organization domain related to how medication information should be recorded (factor loadings=0.51-0.79; Cronbach's coefficient alpha=0.74) and one medications domain related to understanding basics of pharmacology and medication administration (factor loadings=0.37-0.67; alpha=0.70). Item response theory informed the scoring of the response categories and the appropriateness of these items for identifying caregivers who could benefit from training. Structures for teamwork, personhood, and symptoms domains are inconclusive; additional subject recruitment and scale refinement are needed. CONCLUSION: Interim findings suggest that the CG-SEMM instrument may be a promising, psychometrically-valid tool for assessing caregiving skills necessary for managing medications effectively in hospice patients.