title: Family Caregivers' Pain Management in End-of-Life Care: A Systematic Review.
abstract: BACKGROUND
  Pain management was the most identified burden faced by family caregivers in end-of-life caregiving.
  
  
  OBJECTIVE
  To synthesize current scientific evidence on family caregivers' experience of pain management in end-of-life care.
  
  
  METHODS
  A systematic review was conducted using CINAHL, Embase, PubMed, and Cochrane Library electronic databases. Data were extracted from each included paper and organized into tables to synthesize the findings.
  
  
  RESULTS
  Fourteen research papers focusing on family caregivers' experience of pain management and strategies in end-of-life care were included. Nine were observational studies, 3 were case studies, and 2 were experimental studies. These studies mainly focused on exploring family caregivers' engagement in pain management and communication with the hospice care team about pain control; family caregivers' knowledge, skills, and self-efficacy in pain management; and family caregivers' concerns and experience of pain management.
  
  
  CONCLUSIONS
  This review identified themes similar to previous reviews on family caregivers of patients with cancer or in palliative care: inadequate knowledge and assessment skills in pain management, misunderstanding of pain medications, and poor communication with the care team. Future research should design educational programs and material for family caregivers to improve their pain management knowledge and skills, communication, and engagement in care. The scientific knowledge on this topic is scarce, and level of evidence is low; it is therefore imperative to have more exploratory studies to expand the quality and quantity of evidence and increase our understanding of family caregivers' needs and barriers to pain management based on larger and more diverse patient and caregiver samples.
authors.affiliation: 1 School of Nursing, University of Washington, Seattle, WA, USA.
authors.forename: Nai-Ching
authors.initials: NC
authors.lastname: Chi
authors.affiliation: 1 School of Nursing, University of Washington, Seattle, WA, USA.|2 School of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: George
authors.initials: G
authors.lastname: Demiris
mesh_terms: D017028:Caregivers / Q000523:psychology*; D003142:Communication; D007722:Health Knowledge, Attitudes, Practice; D017051:Hospice Care / Q000379:methods / Q000523:psychology; D006801:Humans; D059408:Pain Management / Q000379:methods* / Q000523:psychology*; D010166:Palliative Care / Q000379:methods / Q000523:psychology; D010348:Patient Care Team / Q000458:organization & administration; D020377:Self Efficacy; D013727:Terminal Care / Q000379:methods* / Q000523:psychology*; D035502:Trust
keywords: end-of-life care; family caregiver; hospice care; pain control; pain management; palliative care