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The Journals of Gerontology Series B: Psychological Sciences and Social Sciences Advance Access originally published online on May 23, 2009
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 2009 64B(6):799-807; doi:10.1093/geronb/gbp033
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org.

Family Caregiver Skills in Medication Management for Hospice Patients: A Qualitative Study to Define a Construct

Denys T. Lau1,2, Judith D. Kasper3, Joshua M. Hauser1,2, Celia Berdes1,2, Chih-Hung Chang1,2, Rebecca L. Berman4, Jonathan Masin-Peters1, Judith Paice5 and Linda Emanuel1,2

1 Buehler Center on Aging, Health & Society
2 Department of Medicine, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
3 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
4 Leonard Schanfield Research Institute, CJE SeniorLife, Chicago, Illinois
5 Department of Medicine, Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois

Address correspondence to Denys T. Lau, PhD, Buehler Center on Aging, Health & Society, Northwestern University, Feinberg School of Medicine, 750 North Lake Shore Drive, Suite 601, Chicago, IL 60611. Email: D-lau{at}northwestern.edu


  Abstract

Objectives: To propose a theoretical construct of family caregiver skills in effective medication management for home hospice patients.

Methods: Semistructured face-to-face interviews were conducted with 22 hospice providers (14 nurses, 4 physicians, and 4 social workers) and 23 family caregivers (10 daughters, 4 wives, 2 husbands, and 7 others) of elderly patients (≥60 years old) who were receiving home services from four hospice care programs in the Chicago metropolitan area.

Results: Although both groups identified similar skill sets, hospice providers emphasized technical skills such as administering medications, and family caregivers valued management skills such as organizing medications, coordinating with hired caregivers, and providing care to patients who resisted treatment. We defined effective medication management in hospice as caregivers’ ability to effectively relieve symptoms with pharmacological interventions by successfully utilizing skills related to teamwork (coordinate with hospice providers and with other family or hired caregivers), organization (acquire, store, track, and discard medications), symptom knowledge (recognize and interpret common symptoms), medication knowledge (understand the basics of pharmacology and medication administration), and personhood (understand and respond to the patient's needs).

Discussion: The proposed construct of medication management skills in hospice will help guide future development of training interventions and clinical assessment tools.

Key Words: Caregiver competence • Caregiving • Pain management • Palliative care • Symptom control

Received September 30, 2008; Accepted March 9, 2009

Decision Editor: Kenneth F. Ferraro, PhD


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