Nurse-led intervention helps carers manage medication and cancer pain

A study published today shows the potential benefits of a new nurse-led intervention supporting carers to manage pain medication in people with terminal cancer.

Researchers from the University of Southampton, Cardiff University and University of Leeds have developed a nurse-led intervention to help carers with medication management, and have evaluated its use in routine practice. 

The Cancer Carers’ Medicines Management (CCMM) intervention addresses carers’ beliefs, knowledge and skills, and promotes self-evaluation of competence. It centres on a structured conversational process between a nurse and carer.

Intervention

This is the first time a study has attempted to integrate an intervention developed from the input of carers and nurses into routine palliative care.

The research, funded by Marie Curie and Dimbleby Cancer Care, shows that the CCMM intervention compares favourably with current practice because it offers a systematic and comprehensive approach to supporting carer management of pain medicines. 

Researchers noted that nurses valued the toolkit resource because it includes information about opioids, and simple charts for documenting pain and medication, that are of immediate practical value to carers.

The findings also identify some positive changes in medicines management, such as increased acceptance of the need for opiates; behavioural changes, such as responding more readily to patients’ requests for pain relief; and improvements in systems for giving and recording medicines.

Reliable research

Many people with advanced cancer experience persistent pain and are typically prescribed analgesics, including opioids. Carers often help patients to manage pain medicines, especially near the end of life, but often do not receive the support they need.

Sue Latter, the lead researcher from the University of Southampton, said: ‘Despite the heavy burden placed on carers to help manage pain medication at home, there is a lack of reliable research on effective methods of supporting carers with medicines management. 

‘Medication management requires knowledge and practical skill. It involves carers in monitoring and interpreting symptoms, as well as selecting, administering and evaluating the effectiveness of medicines. 

‘Often, carers will have had no training for their role, and will have preconceived views about pain and analgesics, particularly opioids.’

Potential benefits

Co-author Jane Hopkinson, from Cardiff University, said: ‘Cancer Carers’ Medicines Management made clinical sense to nurses, who recognised the challenges faced by carers managing analgesics at the end of life, and saw potential benefits in improving education and support.'

Most studies conclude that healthcare professionals need to provide carers with more information, training and continuing support.

Marie Curie director of nursing Dee Sissons said: ‘The responsibility of taking on a caring role for someone who is terminally ill can be immensely rewarding, but also daunting. 

‘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. 

Feedback

‘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’ requests for pain relief with greater confidence.’

The nurses who participated in the study also provided feedback on how to use the intervention more widely in palliative care nursing practice.

Their suggestions include: involving patients with other terminal illnesses, including other ‘end of life care’ medication, and introducing it earlier in the course of a patient’s illness to increase benefits to carers.

The study results have informed further NIHR-funded research into nurses supporting patients’ self-management of medicines at the end of life.

Heartening

Responding to Marie Curie's new study on nurse-led intervention helping carers’ manage medication and cancer pain, Amanda Cheesley, RCN professional lead for long-term conditions and end of life care said: ‘It’s heartening that this study acknowledges the role of nurses in supporting carers and people with terminal cancer to manage their pain more effectively.

‘It’s important that carers feel comfortable with managing pain medication and any support they received must be maintained. Nurses recognise the challenges they face and are well placed to build trusting relationships to ensure continuity of care.’ 

The research, published in Palliative Medicine, was funded by the Dimbleby Marie Curie Research Fund.

In other news

• Student faked ID and invented children's identities to defraud NHS of £88,000
• Grenfell Tower nurse challenges MPs over pay cap