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Chew Khai Yen

Evaluation of Material
Title Family Caregiver Skills in Medication Management for Hospice Patients: A
Qualitative Study to Define a Construct
Authors Denys T. Lau, Judith D. Kasper, Joshua M. Hauser, Celia Berdes, Chih-Hung
Chang, Rebecca L. Berman, Jonathan Masin-Peters, Judith Paice, and Linda
Emanuel
Source Journal of Gerontology: Social Sciences, 64B(6), 799-807.
Date of publication March 9, 2009 (Oxford University Press on behalf of The Gerontological
Society of America)

Summary
Based on findings obtained from face-to-face interviews with family caregivers and hospice
providers, the authors of this study proposed a multidimensional construct of family caregiver
skills in medication management for home hospice patients.
Reliability
All the authors of the report are distinguished researchers who at least hold PhD qualifications
in their respective fields and recipients of various awards
1
, thus lending a voice of authority to
the report. Also, the collaboration between nine separate authors as well as the different
backgrounds of which they come from
2
both serve to eliminate any form of personal or
institutional bias from the report, making it a reliable one. The authors also cited a multitude of
works by previous researchers to support their claims throughout the report, indicating a well-
researched effort.
However, as the authors pointed out, the findings of the report cannot be generalised to the
broader population of caregivers as the 45 interviewees are not representative of the general
caregiver profile. Nonetheless, considering that certain aspects of caregiving for elderly hospice
patients is more or less similar universally, the theoretical construct for effective medication
management proposed is still rather relevant and applicable to the general caregiver population.
Usefulness
The authors suggested that a comprehensive understanding of medication management skills
may better prepare caregivers as medication managers to provide effective symptom relief to
patients. These skills, including teamwork, organization, medication knowledge, symptom
knowledge and personhood, were based on feedback provided by hospice providers and family
caregivers and cover both the technical and management aspects of medication administration.
The proposed construct is in line with the COPE (Creativity, Optimism, Planning, Expert Advice)

1
http://www.aging.northwestern.edu/index.php
2
Buchler Center on Aging, Health & Society; Department of Medicine, Division of General Internal
Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Helath
Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Leonard
Schanfield Research Institute, CJE SeniorLife, Chicago Illinois; Department of Medicin, Division of
Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Chew Khai Yen
intervention model that is currently adopted by palliative services to relieve caregiver stress and
improve care quality
3
. The Planning and Expert Advice component of the COPE model is
applicable to the five skills proposed by the authors needed for better medication management.
On the other hand, effective symptom relief should also depend on the patient. If possible, a
conscious patient should play an active role in his own care. The involvement of patients can be
introduced allowing the patient to communicate directly with the hospice providers to enquire
about their own medication and health progress through an online portal. A simple infographic
on the various medications taken by the patient could also be tailor-made by the portal to
facilitate the patients understanding. The patient should take charge of his own care by voicing
out his needs and concerns as well as helping the caregiver in the medication administering
process by remembering when and what to eat.
The authors also mentioned that broader life experience plays a role in skill development for
many caregivers too. The accumulation of caregiving experience over the years and different
patients helps the caregivers to hone medical management skills over repeated practices and
learning. However, the aging population in Singapore suggests that there is going to be a whole
new group of caregivers taking care of their elderly parents without prior experience. While the
five skills proposed by the authors are train-able, there still lacks an element of personal
experience to them and caregivers might lack confidence in their skills. A research
4
showed that
when caregivers are given individualised training intervention instead of just being dependent
on community-based resources, they will experience a significant increase in self-efficacy.
Hence, a system can be created where new caregivers are assigned under the mentorship of an
experienced caregiver who will guide the new caregiver through the learning process based on
his/her experiences. In that way, the new caregiver would be more confident, learn faster and
make fewer mistakes along the way.
(599 words)


3
The COPE intervention was uniquely effective in improving caregivers' overall quality of life and in
decreasing burden related to patients symptoms and caregiving tasks, which are essential goals of hospice
and palliative care McMillan, S. C., Small, B. J., Weitzner, M., Schonwetter, R., Tittle, M., Moody, L. and
Haley, W. E. (2006), Impact of coping skills intervention with family caregivers of hospice patients with
cancer. Cancer, 106: 214222. doi: 10.1002/cncr.21567

(http://onlinelibrary.wiley.com/doi/10.1002/cncr.21567/full)

4
Cristina C. Hendrix, Richard Landerman, and Amy P. Abernethy (2006), Effects of an Individualized
Caregiver Training Intervention on Self-Efficacy of Cancer Caregivers