title: Informal hospice caregiver pain management concerns: a qualitative study.
abstract: BACKGROUND
  Informal, unpaid, family caregivers provide much hospice care in the United States. These caregivers suffer physically, psychologically, emotionally, and socially from the burden of caring. The most often identified area of caregiver burden is the management of end-of-life pain. However, little empirical evidence exists of effective interventions to help caregivers manage end-of-life pain, and issues surrounding caregiver pain management remain vague and undefined. Understanding these concerns will inform the design of effective caregiver interventions.
  
  
  OBJECTIVE
  The purpose of this study was to describe and organize caregiver pain management challenges faced by home hospice caregivers of cancer patients.
  
  
  METHODS
  A content analysis of secondary data, namely, recordings of caregiver interviews, was conducted to describe pain management issues. These interviews were part of a larger clinical trial.
  
  
  METHODS
  Multiple sessions with 29 informal caregivers, of patients dying of cancer, were audio-recorded. Subjects were purposively selected from two hospice programs in the Northwestern United States. Caregivers of noncancer patients were excluded from the study sample.
  
  
  RESULTS
  A framework of six major themes with subordinate subthemes was developed through a literature review and peer review. The framework was used to organize the content of 87 caregiver interviews. The six major themes identified in the analysis included Caregiver-Centric Issues, Caregiver Medication Skills and Knowledge Issues, End-of-Life Symptom Knowledge Issues, Communication and Teamwork Issues, Organizational Skill Issues, and Patient-Centric Issues.
  
  
  CONCLUSIONS
  This analysis clearly articulated and classified caregiver issues surrounding pain management. Future hospice research may benefit from the use of this analysis and framework in the development of tools to alleviate this major cause of caregiver burden.
authors.affiliation: Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA, USA.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Kelley
authors.forename: George
authors.initials: G
authors.lastname: Demiris
authors.forename: Huong
authors.initials: H
authors.lastname: Nguyen
authors.forename: Debra P
authors.initials: DP
authors.lastname: Oliver
authors.forename: Elaine
authors.initials: E
authors.lastname: Wittenberg-Lyles
mesh_terms: D000569:Americas / Q000453:epidemiology; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D005260:Female; D017051:Hospice Care / Q000458:organization & administration* / Q000592:standards*; D006801:Humans; D008297:Male; D009369:Neoplasms; D015205:Northwestern United States; D059408:Pain Management / Q000592:standards*; D036301:Qualitative Research; D014481:United States / Q000453:epidemiology
keywords: Caregivers; end-of-life; hospice care; pain; pain management; palliative care