Improving medication management in home hospice patients: A pilot study of the MedCoach intervention for informal caregivers

OBJECTIVES: Many informal caregivers report feeling under-prepared about managing medications for patients near the end-of-life. This pilot study evaluates a novel intervention – MedCoach – that combines video and written materials to better equip caregivers in effectively managing medications for home hospice patients. METHODS: A convenience sample of 20 caregivers participating in MedCoach during 2 home visits within 5 days (cases) and 20 caregivers selected from a larger study receiving usual care (controls) was recruited from 5 Chicago-based hospice agencies. Cases and controls were matched on age (+/-10 years), sex, and race. Baseline and follow-up computer-assisted telephone surveys, conducted approximately 7 days apart, collected data on sociodemographic factors, caregiver's knowledge/attitudes toward medication management; caregiver's stress, preparedness, and locus of control; and caregiver-reported patient's symptom severity and health-related quality of life. RESULTS: Cases and controls were well matched. The mean caregiver's age was 57. Most were female offspring, White, and had no college degree. Most were managing >7 medications and caring for a patient with dementia or cancer. Compared to controls, changes among cases between baseline and follow-up were significantly greater with improved knowledge/attitudes toward overall medication management (p<0.001) and internal locus of control (p<0.05). However, caregiver-reported patient's symptom severity scores appeared to increase more significantly among cases than among controls (p<0.05). No detectable differences were observed for the other measures between study arms. DISCUSSION: MedCoach may be a promising hospice intervention but needs further investigation. Higher symptom severity scores suggest that MedCoach may increase caregivers' awareness of patient symptom severity.