Tjia Jennifer, Clayton Margaret F, Puerto Geraldine, Duodu Vennesa, Troiani Francesca, Tanikella Sruthi, DeSanto-Madeya Susan
Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA.
College of Nursing, University of Utah, Salt Lake City, Utah, USA.
J Palliat Med. 2024 Dec;27(12):1653-1656. doi: 10.1089/jpm.2024.0229. Epub 2024 Oct 28.
Medication management in home hospice is challenging for family caregivers (FCGs). We tested a patient-centered medication review and FCG support program delivered by hospice staff called "Shared Medication PLanning In (SiMPLIfy) Home Hospice." A pilot cluster-randomized trial at two U.S. home hospice agencies measured the primary outcome of reduction in Medication Regimen Complexity Index (MRCI) (range 0 [no medications]-no upper limit) and secondary outcome of Family Caregiver Medication Administration Hassle Scale (FCMAHS) (range 0 [no hassle-120 [greatest hassle]). Twenty-two patient-FCG dyads enrolled. Mean baseline MRCI in the intervention group = 39 (95% CI: 30.9, 47.1) and control group = 25.5 (95% CI: 21.0-30.1). Half of intervention patients (3 of 6) had reduced MRCI compared with 26.7% (4 of 15) control patients ( = 0.07). MRCI was not significantly associated with caregiver burden. FCMAHS differed between spousal and nonspousal FCGs ( = 0.12). A clinician-FCG-patient communication program in home hospice is feasible and may reduce medication complexity. SiMPLIfy has the potential to reduce polypharmacy.
居家临终关怀中的药物管理对家庭照护者（FCG）而言具有挑战性。我们测试了一项由临终关怀工作人员提供的以患者为中心的药物审查和FCG支持项目，名为“居家临终关怀共享药物规划（简化版）（SiMPLIfy）”。在美国两家居家临终关怀机构进行的一项试点整群随机试验，测量了药物治疗方案复杂性指数（MRCI）降低（范围为0[无药物] - 无上限）这一主要结局，以及家庭照护者药物管理麻烦量表（FCMAHS）（范围为0[无麻烦] - 120[最大麻烦]）这一次要结局。纳入了22对患者 - FCG组合。干预组的平均基线MRCI = 39（95%置信区间：30.9，47.1），对照组 = 25.5（95%置信区间：21.0 - 30.1）。与26.7%（15例中的4例）的对照组患者相比，干预组中有一半的患者（6例中的3例）MRCI降低（P = 0.07）。MRCI与照护者负担无显著关联。配偶与非配偶FCG的FCMAHS存在差异（P = 0.12）。居家临终关怀中的临床医生 - FCG - 患者沟通项目是可行的，且可能降低药物复杂性。SiMPLIfy有减少多重用药的潜力。
