Secondary Analysis of Caregiver Pain Management Issues during Telehospice versus In-person Interventions

Thesis (Master's)--University of Washington, 2012Most hospice care in the US is provided in the home by lay family caregivers. These caregivers suffer physically, psychologically, emotionally, and socially from the burden of caring. The most often identified area of burden for caregivers is the management of end-of-life pain. Despite advances in pain management pharmacology and alternative therapies, unrelieved pain continues to plague patients and their care providers. Although pain management has been targeted as a national healthcare concern and research priority, specific issues of caregiver pain management remain vague and undefined. Understanding issues surrounding caregiver pain management may help clarify needs thus enabling the creation of cost effective, tools, technologies, and interventions to help caregivers' and ultimately dying patient. The purpose of this study was to describe caregiver pain management issues during end-of-life (EOL) care and compare issues identified by those caregivers receiving a telehospice intervention to those receiving a face-to-face intervention. The primary aim was to describe specific pain management challenges associated with home hospice caregivers. The secondary aim was to compare pain management issues using telehospice versus face-to-face interventions. A directed content analysis of secondary data was conducted to describe pain management issues expressed by caregivers during EOL care. Six major themes, Caregiver-Centric Issues, Caregiver Medication Skills and Knowledge, EOL Symptom Knowledge Issues, Teamwork & Communication Issues, Organizational Skill Issues, and Patient-Centric Issues, were identified through a literature review. These themes were the starting point for the directed content analysis. Interviews from 29 caregivers, of loved ones dying of cancer, were reviewed and coded using NVivo 9 software. Themes concerning Caregiver Centric Issues and Teamwork & Communication Issues were most prevalent in the data. Rich, descriptive accounts of the themes were discovered in both the telehospice and the face-to-face groups. No significant differences were found between the two groups. By clearly identifying themes, perhaps more empirical research can be conducted to help advance more efficacious caregiver interventions