Payne Sheila, Turner Mary, Seamark David, Thomas Carol, Brearley Sarah, Wang Xu, Blake Susan, Milligan Christine
International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
Honiton Group Practice, Devon, UK.
BMJ Support Palliat Care. 2015 Jun;5(2):181-8. doi: 10.1136/bmjspcare-2014-000658. Epub 2014 Sep 25.
To explore how bereaved family members recall managing end of life medications when delivering care to a patient dying at home in England.
Qualitative study.
Domestic homes in two contrasting areas in England.
59 bereaved family carers who have delivered care to a patient who spent a minimum of 2 weeks at home prior to their death from cancer or other non-malignant condition. Cases were excluded if the place of death was: a hospice, nursing home or National Health Service (NHS) hospital.
Participants identified a number of important concerns about managing end of life medication for the dying person at home. Although some support with medications is provided by general practitioners and nurses in the community, family carers take primary responsibility for drug administration and storage. They reported anxiety about giving correct and timely dosages, and concerns about keeping the patient comfortable without overdosing them or risking shortening their lives. In particular, they reported that certain analgesic medications, especially opioids, were considered to have a symbolic significance increasing analgesia requirements, and the use of a syringe driver was associated with deterioration and approaching death. Key barriers to managing end of life medications at home included: complex regimes; unwanted responsibility in deciding when to use 'as needed' medication; disagreements with professional staff, and anxiety about medication errors, especially if perceived to have implications for survival.
Family carers require more information about end of life drugs and their effects, support and training in managing medication for a dying person.
探讨在英国，丧亲家庭成员在为在家中临终的患者提供护理时，如何回忆管理临终药物的情况。
定性研究。
英国两个形成对比的地区的家庭住所。
59名丧亲的家庭护理人员，他们曾为一名在因癌症或其他非恶性疾病去世前至少在家中度过2周的患者提供护理。如果死亡地点是：临终关怀机构、养老院或国民健康服务（NHS）医院，则将病例排除。
参与者确定了在家中为临终患者管理临终药物的一些重要问题。尽管社区中的全科医生和护士会提供一些药物方面的支持，但家庭护理人员对药物的给药和储存承担主要责任。他们报告了在正确及时给药方面的焦虑，以及在让患者舒适的同时避免用药过量或缩短其生命的担忧。特别是，他们报告说某些镇痛药物，尤其是阿片类药物，被认为具有增加镇痛需求的象征意义，而使用注射泵与病情恶化和临近死亡有关。在家中管理临终药物的主要障碍包括：复杂的用药方案；在决定何时使用“按需”药物时承担不必要的责任；与专业人员的分歧，以及对用药错误的焦虑，特别是如果认为用药错误会影响患者生存。
家庭护理人员需要更多关于临终药物及其效果的信息，以及在为临终患者管理药物方面的支持和培训。
