WHAT WAS LEARNED
The investigators found the CCMM intervention compared well with current practice. It provided a more systematic and comprehensive approach to supporting caregiver management of patient care. In addition, the team found the intervention was acceptable to the nurses as well as the caregivers. The study demonstrated this is a feasible approach that could be easily adopted in any community.
Nurses participating in the pilot study particularly valued the toolkit resource, which included information about opioids and simple charts for documenting pain and medication administration. This resource also proved to be of immediate practical value to the caregivers. The study results revealed positive behavioral changes in medication management such as better understanding of opiate use and improved response to patients’ requests for pain relief. Current systems used to record medication administration were also improved with use of CCMM, the researchers reported.
“Managing pain medicines in the home is a complex task. A structured approach to education in the necessary knowledge and practical skills can help cancer carers feel able to assist patients in the management of pain,” Ms Hopkinson told Oncology Nurse Advisor.
IMPLICATIONS FOR NURSES
The researchers noted that at-home management of pain medications for patients with cancer can be difficult and stressful for the caregivers. Yet, there is a significant lack of reliable research on effective methods for supporting caregivers of this patient population.
In most cases, caregivers are expected to administer medications, evaluate their effectiveness, then appropriately monitor the patient and interpret symptoms with little or no training. Furthermore, many have preconceived views about pain and opioid use. These issues must be addressed, explained Amy Allen Case, MD, clinical chief and associate professor of oncology, Department of Supportive and Palliative Care, Roswell Park Cancer Institute.
“I’m not surprised by these findings, but I am encouraged to see increasing evidence on how to make palliative approaches as effective and efficient as possible. Any type of intervention focused on helping caregivers is worthwhile and reflects an underused opportunity to improve both outcomes and quality of life for cancer patients,” Dr Case told Oncology Nurse Advisor.
She said cancer centers in the United States are increasingly recognizing that deeper and more meaningful engagement with caregivers can reduce hospital stays and incidence of infections and complications. Dr Case said that greater engagement with the caregivers can lead to improved patient care while helping the caregivers at a critical time with “everything from medication management and instruction in wound care to guidance on how to juggle the stresses they’re facing,” said Dr Case.
The researchers suggest that health care professionals provide caregivers with more information, training, and continuing support. “Carer education is an evolving area of oncology practice. This is because cancer services are moving closer to home, partly in response to patient preference. In the future, we hope to extend the scope of the CCMM toolkit to include medicines used to manage other cancer symptoms in the community,” said Ms Hopkinson.
1. Latter S, Hopkinson JB, Lowson E, et al. Supporting carers to manage pain medication in cancer patients at the end of life: a feasibility trial [published online July 5, 2017]. Palliat Med. doi: 10.1177/0269216317715197