A nurse-led intervention designed to help carers manage pain medication for loved-ones dying from cancer has helped improved understanding and delivery of pain relief, according to results from a trial.
The Cancer Carers’ Medicines Management (CCMM) intervention sees nurses receive special training on how to support carers, who frequently play a key role in organising and administering pain relief during a relative’s final days at home but often don’t get the help they need.
It was developed by researchers from the universities of Southampton, Cardiff and Leeds, who evaluated its effectiveness when integrated into routine palliative care in a study published today in the journal Palliative Medicine.
“Medication management requires knowledge and practical skill, and involves carers in monitoring and interpreting symptoms”
Professor Sue Latter
“Medication management requires knowledge and practical skill, and involves carers in monitoring and interpreting symptoms, as well as selecting, administering and evaluating the effectiveness of medicines,” said Professor Sue Latter, the lead researcher from the University of Southampton.
But despite the “heavy burden” placed on carers who face the daunting task of managing strong pain relief drugs, including opioids, at home there is a lack of research on how best to support them, she added.
The study, which was funded by charities Marie Curie and Dimbleby Cancer Care, saw CCMM tested at two locations – one in South Wales and one in southern England.
The intervention, which comes with practical resources such as simple charts for recording pain and medication, and information about drugs, aims to boost carers’ knowledge, skills and confidence and improve the welfare and comfort of the person they are caring for.
In Wales it was tested by district nurses with generic caseloads that included patients with palliative care needs. Meanwhile the trial in England saw specialist nurses, who were employed by two hospices to work in the community, deliver the intervention.
”The responsibility of taking on a caring role for someone who is terminally ill can be immensely rewarding, but also daunting”
Findings from the study – called Supporting family caregivers to manage pain medication in cancer patients at end of life: a feasibility trial - showed CCMM offered a more systematic and comprehensive approach to supporting carers with management of pain medication.
Researchers identified positive changes including carers responding more readily to patients’ request for pain relief and better systems for giving and recording medicines.
They also found the structured conversations with nurses – who provided ongoing follow-up support in person and on the phone – had increased carers’ acceptance and understanding of the need for strong pain relief.
Carers who have not received any special training often have “preconceived views” about pain and certain drugs, particularly opioids, explained Professor Latter.
The study also found the approach was welcomed by nurses who recognised the challenges faced by carers.
“This new study shows that nurses and carers can work together to better manage pain medication at home”
“The responsibility of taking on a caring role for someone who is terminally ill can be immensely rewarding, but also daunting,” said Dee Sissons, director of nursing at Marie Curie.
“Family carers play a critical role in supporting people with a terminal illness so they can be cared for and die at home when this is their wish,” she said.
“This new study shows that nurses and carers can work together to better manage pain medication at home and enable carers to respond more readily to their loved ones request for pain relief with greater confidence,” she added.
The nurses who participated in the study also made suggestions about how the approach could be used more widely in palliative care nursing such as involving patients with other terminal illnesses and providing information on more different types of medication.