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Chew Khai Yen

Evaluation of Material Title Authors

Source Date of publication

Family Caregiver Skills in Medication Management for Hospice Patients: A Qualitative Study to Define a Construct Denys T. Lau, Judith D. Kasper, Joshua M. Hauser, Celia Berdes, Chih-Hung Chang, Rebecca L. Berman, Jonathan Masin-Peters, Judith Paice, and Linda Emanuel Journal of Gerontology: Social Sciences, 64B(6), 799-807. March 9, 2009 (Oxford University Press on behalf of The Gerontological Society of America)

Summary Based on findings obtained from face-to-face interviews with family caregivers and hospice providers, the authors of this study proposed “a multidimensional construct of family caregiver skills in medication management for home hospice patients”. Reliability All the authors of the report are distinguished researchers who at least hold PhD qualifications in their respective fields and recipients of various awards1, thus lending a voice of authority to the report. Also, the collaboration between nine separate authors as well as the different backgrounds of which they come from2 both serve to eliminate any form of personal or institutional bias from the report, making it a reliable one. The authors also cited a multitude of works by previous researchers to support their claims throughout the report, indicating a wellresearched effort. However, as the authors pointed out, the findings of the report cannot be generalised to the broader population of caregivers as the 45 interviewees are not representative of the general caregiver profile. Nonetheless, considering that certain aspects of caregiving for elderly hospice patients is more or less similar universally, the theoretical construct for effective medication management proposed is still rather relevant and applicable to the general caregiver population. Usefulness The authors suggested that a comprehensive understanding of medication management skills may better prepare caregivers as medication managers to provide effective symptom relief to patients. These skills, including teamwork, organization, medication knowledge, symptom knowledge and personhood, were based on feedback provided by hospice providers and family caregivers and cover both the technical and management aspects of medication administration. The proposed construct is in line with the COPE (Creativity, Optimism, Planning, Expert Advice) 1

http://www.aging.northwestern.edu/index.php Buchler Center on Aging, Health & Society; Department of Medicine, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Helath Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Leonard Schanfield Research Institute, CJE SeniorLife, Chicago Illinois; Department of Medicin, Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. 2

Chew Khai Yen intervention model that is currently adopted by palliative services to relieve caregiver stress and improve care quality3. The Planning and Expert Advice component of the COPE model is applicable to the five skills proposed by the authors needed for better medication management. On the other hand, effective symptom relief should also depend on the patient. If possible, a conscious patient should play an active role in his own care. The involvement of patients can be introduced allowing the patient to communicate directly with the hospice providers to enquire about their own medication and health progress through an online portal. A simple infographic on the various medications taken by the patient could also be tailor-made by the portal to facilitate the patient’s understanding. The patient should take charge of his own care by voicing out his needs and concerns as well as helping the caregiver in the medication administering process by remembering when and what to eat. The authors also mentioned that broader life experience plays a role in skill development for many caregivers too. The accumulation of caregiving experience over the years and different patients helps the caregivers to hone medical management skills over repeated practices and learning. However, the aging population in Singapore suggests that there is going to be a whole new group of caregivers taking care of their elderly parents without prior experience. While the five skills proposed by the authors are “train-able”, there still lacks an element of personal experience to them and caregivers might lack confidence in their skills. A research4 showed that when caregivers are given individualised training intervention instead of just being dependent on community-based resources, they will experience a significant increase in self-efficacy. Hence, a system can be created where new caregivers are assigned under the mentorship of an experienced caregiver who will guide the new caregiver through the learning process based on his/her experiences. In that way, the new caregiver would be more confident, learn faster and make fewer mistakes along the way. (599 words)

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“The COPE intervention was uniquely effective in improving caregivers' overall quality of life and in decreasing burden related to patients symptoms and caregiving tasks, which are essential goals of hospice and palliative care” McMillan, S. C., Small, B. J., Weitzner, M., Schonwetter, R., Tittle, M., Moody, L. and Haley, W. E. (2006), Impact of coping skills intervention with family caregivers of hospice patients with cancer. Cancer, 106: 214–222. doi: 10.1002/cncr.21567 (http://onlinelibrary.wiley.com/doi/10.1002/cncr.21567/full) 4

Cristina C. Hendrix, Richard Landerman, and Amy P. Abernethy (2006), Effects of an Individualized Caregiver Training Intervention on Self-Efficacy of Cancer Caregivers