How can we help family carers manage pain medicines for patients with advanced cancer? A systematic review of intervention studies

Latter, Sue; Hopkinson, Jane B.; Richardson, Alison; Hughes, Jane; Lowson, Elizabeth; Edwards, Deborah

doi:10.1136/bmjspcare-2015-000958

Cited by 38 publications

(35 citation statements)

References 51 publications

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“…This study explored patients’ perspectives about community pharmacy services in the context of pain management in advanced cancer. Our findings confirm those of other studies that there is unmet need for additional medicines support for some patients (and their carers) during pain management in palliative care in cancer (Adam et al., ; Bennett, Bagnall, et al., ; Closs et al., ; Latter, Hopkinson, Richardson, Hughes, & Edwards, ). Similar numbers of patients in this study were receiving and not receiving specialist palliative care services therefore allowing insight into the needs, experiences and perceptions of both groups.…”

Section: Discussionsupporting

confidence: 90%

How do patients with cancer pain view community pharmacy services? An interview study

Edwards

Blenkinsopp

Ziegler

et al. 2018

Health Soc Care Community

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Pain experienced by many patients with advanced cancer is often not well controlled and community pharmacists are potentially well placed to provide support. The study objective was to explore the views and experiences of patients with advanced cancer about community pharmacies, their services and attitudes towards having a community pharmacist pain medicines consultation. Purposive sampling of GP clinical information systems was used to recruit patients with advanced cancer, living in the community and receiving opioid analgesics in one area of England, UK between January 2015 and July 2016. Thirteen patients had a semi-structured interview which was audio-recorded and transcribed verbatim. Data were analysed deductively and inductively using Framework analysis and incorporating new themes as they emerged. The framework comprised Pain management, Experiences and expectations, Access to care and Communication. All patients reported using one regular community pharmacy citing convenience, service and staff friendliness as influential factors. The idea of a community pharmacy medicines consultation was acceptable to most patients. The idea of telephone consultations was positively received but electronic media such as Skype was not feasible or acceptable for most. Patients perceived a hierarchy of health professionals with specialist palliative care nurses at the top (due to their combined knowledge of their condition and medicines) followed by GPs then pharmacists. Patients receiving specialist palliative care described pain that was better controlled than those who were not. They thought medicines consultations with a pharmacist could be useful for patients before referral for palliative care. There is a need for pain medicines support for patients with advanced cancer, and unmet need appears greater for those not under the care of specialist services. Medicines consultations, in principle, are acceptable to patients both in person and by telephone, and the latter was perceived to be of particular benefit to patients less able to leave the house.

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Section: Discussionsupporting

confidence: 90%

How do patients with cancer pain view community pharmacy services? An interview study

Edwards

Blenkinsopp

Ziegler

et al. 2018

Health Soc Care Community

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“…Previous research suggests that carers especially struggle with knowing what to monitor, how to interpret symptoms, and when to seek professional help . Fortunately, educational interventions can be successful in improving carers' confidence in medication management …”

Section: Discussionmentioning

confidence: 99%

Health status in South Australians caring for people with cancer: A population‐based study

et al. 2019

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Objectives To compare physical and mental health status between cancer carers versus non‐carers in a population‐based sample and explore sociodemographic and caring characteristics associated with poor carer health status. Methods The South Australian Health Omnibus is a population‐based cross‐sectional survey. Carer status was self‐defined by participants as having cared for someone with cancer in the last 5 years. Health status was considered poor if it was 0.5 standard deviation lower than Australian norms on the Medical Outcomes Study 12‐Item Short‐Form (SF‐12) physical and mental component summary scores (PCS and MCS). Regression analyses compared mean PCS/MCS between carers versus non‐carers, controlling for sociodemographic variables, and explored associations between poor health status and caring and support among carers. Results The weighted sample included 2962 people, of whom 374 (12.6%) were cancer carers and 1993 (67.3%) non‐carers. Carers had significantly worse PCS/MCS, controlling for sociodemographic variables, but did not differ significantly regarding proportions with poor health status. Carer characteristics associated with poor PCS and MCS included socio‐economic indicators and involvement in medication management. Assisting with household tasks was protective. Conclusions This population‐based study followed those previous ones in finding cancer carers to have poorer mean health status than non‐carers. However, differences were less pronounced than previously reported, likely because of the sample being drawn from a general rather than cancer service population and including past as well as current carers, as well as all cancer types and stages. Future longitudinal research is needed to identify factors that predict recovery post caring.

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“…The authors conclude that 'to date no UK research has systematically charted and evaluated patient experience of medicines access during the last year of life.' Internationally, research also repeatedly highlights patients' and carers' needs for information about medicines in the EoL context (14,15) and our recent systematic review evaluating educational interventions to help carers manage medicines on behalf of patients in the home highlighted that solutions remain elusive (2). Our recent studies (3,4,16) have focused on developing and testing education-focused interventions for pain and related medicines management in the home.…”

Section: Background and Rationalementioning

confidence: 99%

Accessing medicines at end-of-life: an evaluation of service provision

Campling¹

2018

http://isrctn.com/

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Background: Patient / carer access to medicines at end-of-life (EoL) is critical for control of symptoms, including pain and distress and recent evidence confirms end-of-life medicines optimisation is a research priority for patients and carers (1, 2). Anecdotal data from our recent studies (3, 4) suggests the prescription, dispensing, supply and associated information given about medicines (medicines access) is experienced by patients as often difficult, complex, demanding, lacking coordination and involves a multiplicity of professionals and services. Some of these problems were associated with GPs', who are main providers of EoL care delivery. Nurses often also take a lead role in providing community-based EoL care, but evidence suggests that here too there might be problems: prescribing by palliative care nurses has not been exploited to its full potential (5) and nurses find it difficult to access GPs for EoL prescriptions (6). Moreover, community pharmacists' expertise in palliative care medicines optimisation remains underdeveloped (7, 8). Furthermore, whilst there are promising innovations in EoL service delivery, little is known about the impact of these on patient access to medicines, and their cost effectiveness remains largely unevaluated. We will investigate these issues and draw together findings to provide a comprehensive, critical evaluation of current practice, highlighting best practice, challenges and generating expertinformed solutions.

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How can we help family carers manage pain medicines for patients with advanced cancer? A systematic review of intervention studies

Cited by 38 publications

References 51 publications

How do patients with cancer pain view community pharmacy services? An interview study

How do patients with cancer pain view community pharmacy services? An interview study

Health status in South Australians caring for people with cancer: A population‐based study

Accessing medicines at end-of-life: an evaluation of service provision

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