School of Health Sciences, University of Nottingham, Nottingham, UK.
Nottingham Centre for the Advancement of Research in End of life care (NCARE), B302 School of Health Sciences, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
BMC Palliat Care. 2020 May 11;19(1):66. doi: 10.1186/s12904-020-0537-z.
The management of medicines towards the end of life can place increasing burdens and responsibilities on patients and families. This has received little attention yet it can be a source of great difficulty and distress patients and families. Dose administration aids can be useful for some patients but there is no evidence for their wide spread use or the implications for their use as patients become increasing unwell. The study aimed to explore how healthcare professionals describe the support they provide for patients to manage medications at home at end of life.
Qualitative interview study with thematic analysis. Participants were a purposive sample of 40 community healthcare professionals (including GPs, pharmacists, and specialist palliative care and community nurses) from across two English counties.
Healthcare professionals reported a variety of ways in which they tried to support patients to take medications as prescribed. While the paper presents some solutions and strategies reported by professional respondents it was clear from both professional and patient/family caregiver accounts in the wider study that rather few professionals provided this kind of support. Standard solutions offered included: rationalising the number of medications; providing different formulations; explaining what medications were for and how best to take them. Dose administration aids were also regularly provided, and while useful for some, they posed a number of practical difficulties for palliative care. More challenging circumstances such as substance misuse and memory loss required more innovative strategies such as supporting ways to record medication taking; balancing restricted access to controlled drugs and appropriate pain management and supporting patient choice in medication use.
The burdens and responsibilities of managing medicines at home for patients approaching the end of life has not been widely recognised or understood. This paper considers some of the strategies reported by professionals in the study, and points to the great potential for a more widely proactive stance in supporting patients and family carers to understand and take their medicines effectively. By adopting tailored, and sometimes, 'outside the box' thinking professionals can identify immediate, simple solutions to the problems patients and families experience with managing medicines.
在生命末期管理药物会给患者和家属带来越来越多的负担和责任。尽管这一问题尚未得到广泛关注，但它可能会给患者和家属带来巨大的困难和痛苦。剂量给药辅助器具对于一些患者可能会有所帮助，但目前还没有证据表明它们的广泛使用，以及在患者病情不断恶化的情况下使用这些器具的影响。本研究旨在探讨医护人员如何描述他们为在家中临终的患者提供管理药物的支持。
采用定性访谈研究和主题分析。参与者是来自英格兰两个郡的 40 名社区医护人员（包括全科医生、药剂师、专科姑息治疗和社区护士）的目的性抽样。
医护人员报告了他们试图支持患者按规定服药的各种方式。虽然本文介绍了专业受访者报告的一些解决方案和策略，但从更广泛研究中的专业人士和患者/家庭护理人员的描述中可以清楚地看出，很少有专业人士提供这种支持。提供的标准解决方案包括：合理化药物数量；提供不同的剂型；解释药物的用途以及最佳服用方法。还定期提供剂量给药辅助器具，虽然对一些人有用，但对姑息治疗来说，它们也带来了一些实际困难。更具挑战性的情况，如药物滥用和记忆力减退，需要更具创新性的策略，例如支持记录药物服用的方法；平衡对管制药物的限制获取和适当的疼痛管理，并支持患者在药物使用方面的选择。
在家中管理临终患者药物的负担和责任尚未得到广泛认可或理解。本文考虑了研究中专业人员报告的一些策略，并指出在支持患者和家属理解并有效服用药物方面，采取更广泛的积极主动立场具有巨大潜力。通过采用量身定制的、有时甚至是“跳出框框”的思维方式，专业人员可以为患者和家属在管理药物方面遇到的问题找到直接、简单的解决方案。
