Professor UMass Chan Medical School UMass Chan Medical School Worcester, United States
Background: Family caregivers are responsible for medication administration in home hospice, where medication regimens typically include 10 or more daily drugs. Whether the burden of medication administration is associated with regimen complexity or caregiver relationship to the patient is unknown.
Objectives: To examine the association of medication regimen complexity with caregiver medication administration burden in home hospice.
Methods: We conducted a pilot clinical trial of an educational intervention for home hospice nurses that aimed to standardize the approach to discussions regarding goal concordant prescribing and deprescribing. In this context, we measured burden of medication management using the Family Caregiver Medication Administration Hassle Scale (FCMAHS) and patient Medication Regimen Complexity Index (MRCI). We used one-way ANOVA to examine the association between baseline Hassle Scale score and caregiver relationship to the hospice patient. We used unadjusted linear regression to examine the association between baseline Medication Regimen Complexity Index and Hassle Scale score.
Results: A total of 22 patients enrolled in the trial and 21 had a caregiver participate, including 7 spouses, 12 children, and 2 other caregivers. Most caregivers (76%) were extremely involved in managing hospice medications. At baseline, mean MRCI was 30.4 (SD 11.9; range 10-66) and the mean Hassle Scale score was 25.5 (SD 4.2; range 0-60). There was no significant association between increasing MRCI and Caregiver Hassle Score (beta coef -0.13, P=0.73). There was a significant association with caregiver relationship and Caregiver Hassle Score (mean spousal Hassle Score = 17.4 [SD 13.8]; mean children caregiver Hassle Score = 39.1 [SD 19.1]; mean other caregiver Hassle Score = 8.5 [SD10.6]; p=0.048).
Conclusions: Family caregivers reported a wide range of medication administration hassle. Higher medication administration hassle was associated with caregiver relationship with the hospice patient, but not MRCI. When considering the burden of medication administration in home hospice, it is important to understand that the caregiver’s relationship to the hospice patient can affect this perceived burden.
