Pain medication management processes used by oncology outpatients and family caregivers part I: health systems contexts.
BACKGROUND
Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management.


OBJECTIVE
The aim was to describe day-to-day pain medication management from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management by patients and family caregivers in the context of multiple complex health systems.


METHODS
We qualitatively analyzed audio-recorded intervention sessions that included extensive dialogue between patients, family caregivers, and nurses about pain medication management during the 10-week intervention.


RESULTS
The health systems context for pain medication management included multiple complex systems for clinical care, reimbursement, and regulation of analgesic prescriptions. Pain medication management processes particularly relevant to this context were getting prescriptions and obtaining medications. Responsibilities that fell primarily to patients and family caregivers included facilitating communication and coordination among multiple clinicians, overcoming barriers to access, and serving as a final safety checkpoint. Significant effort was required of patients and family caregivers to insure safe and effective pain medication management.


CONCLUSIONS
Health systems issues related to access to needed analgesics, medication safety in outpatient settings, and the effort expended by oncology patients and their family caregivers require more attention in future research and health-care reform initiatives.
College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA. Electronic address: kschumacher@unmc.edu.
Karen L
KL
Schumacher
University of Cincinnati, Cincinnati, Ohio, USA.
Vicki L
VL
Plano Clark
University of California, San Francisco, San Francisco, California, USA.
Claudia M
CM
West
University of California, San Francisco, San Francisco, California, USA.
Marylin J
MJ
Dodd
University of California, San Francisco, San Francisco, California, USA.
Michael W
MW
Rabow
University of California, San Francisco, San Francisco, California, USA.
Christine
C
Miaskowski
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000191:economics / Q000627:therapeutic use*; D017028:Caregivers / Q000523:psychology; D005190:Family / Q000523:psychology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology / Q000628:therapy; D009726:Nurses; D010045:Outpatients / Q000523:psychology; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology; D059408:Pain Management / Q000191:economics / Q000379:methods*; D010353:Patient Education as Topic; D012648:Self Care / Q000191:economics / Q000379:methods
D000700:Analgesics
Cancer pain management; analgesics; family caregivers; health systems; medication management; medication safety; qualitative research; randomized clinical trial; self-care; self-management