Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA, USA.
Palliat Med. 2013 Jul;27(7):673-82. doi: 10.1177/0269216313483660. Epub 2013 Apr 23.
Informal, unpaid, family caregivers provide much hospice care in the United States. These caregivers suffer physically, psychologically, emotionally, and socially from the burden of caring. The most often identified area of caregiver burden is the management of end-of-life pain. However, little empirical evidence exists of effective interventions to help caregivers manage end-of-life pain, and issues surrounding caregiver pain management remain vague and undefined. Understanding these concerns will inform the design of effective caregiver interventions.
The purpose of this study was to describe and organize caregiver pain management challenges faced by home hospice caregivers of cancer patients.
A content analysis of secondary data, namely, recordings of caregiver interviews, was conducted to describe pain management issues. These interviews were part of a larger clinical trial.
SETTING/PARTICIPANTS: Multiple sessions with 29 informal caregivers, of patients dying of cancer, were audio-recorded. Subjects were purposively selected from two hospice programs in the Northwestern United States. Caregivers of noncancer patients were excluded from the study sample.
A framework of six major themes with subordinate subthemes was developed through a literature review and peer review. The framework was used to organize the content of 87 caregiver interviews. The six major themes identified in the analysis included Caregiver-Centric Issues, Caregiver Medication Skills and Knowledge Issues, End-of-Life Symptom Knowledge Issues, Communication and Teamwork Issues, Organizational Skill Issues, and Patient-Centric Issues.
This analysis clearly articulated and classified caregiver issues surrounding pain management. Future hospice research may benefit from the use of this analysis and framework in the development of tools to alleviate this major cause of caregiver burden.
在美国，非专业、无偿的家庭护理人员提供了大量的临终关怀服务。这些护理人员在身体、心理、情感和社交方面承受着照顾的负担。护理人员负担最常被确定的领域是临终疼痛的管理。然而，几乎没有有效的干预措施来帮助护理人员管理临终疼痛的实证证据，并且围绕护理人员疼痛管理的问题仍然模糊和未定义。了解这些问题将为设计有效的护理人员干预措施提供信息。
本研究的目的是描述和组织家庭临终关怀癌症患者护理人员面临的疼痛管理挑战。
对二次数据（即护理人员访谈记录）进行内容分析，以描述疼痛管理问题。这些访谈是一项更大的临床试验的一部分。
设置/参与者：对来自美国西北部的两个临终关怀项目的 29 名非正式护理人员进行了多次访谈，并进行了音频记录。护理人员是通过目的抽样选择的，他们的患者正在死亡。非癌症患者的护理人员被排除在研究样本之外。
通过文献回顾和同行评审，开发了一个包含六个主要主题和下属子主题的框架。该框架用于组织 87 名护理人员访谈的内容。分析中确定的六个主要主题包括以护理人员为中心的问题、护理人员药物技能和知识问题、临终症状知识问题、沟通和团队合作问题、组织技能问题以及以患者为中心的问题。
这项分析清楚地阐明和分类了与疼痛管理相关的护理人员问题。未来的临终关怀研究可能受益于使用这种分析和框架来开发减轻这种主要护理人员负担的工具。
