Pain Medication Management Processes Used by Oncology Outpatients and Family Caregivers Part II: Home and Lifestyle Contexts

Authors

Karen Schumacher, University of Nebraska Medical Center, OmahaFollow
Vicki L. Plano Clark, University of CincinnatiFollow
Claudia M. West, University of California, San FranciscoFollow
Marylin J. Dodd, University of California, San Francisco
Michael W. Rabow, University of California, San Francisco
Christine Miaskowski, University of California, San FranciscoFollow

Date of this Version

2014

Citation

J Pain Symptom Manage. 2014 November ; 48(5): 784–796.

Comments

© 2014 U.S. Cancer Pain Relief Committee.

doi:10.1016/j.jpainsymman.2013.12.247

Abstract

Context—Despite the increasing complexity of medication regimens for persistent cancer pain, little is known about how oncology outpatients and their family caregivers manage pain medications at home. Objectives—To describe the day-to-day management of pain medications from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial (RCT) of a psycho-educational intervention called the Pro-Self © Plus Pain Control Program. In this article, we focus on pain medication management in the context of highly individualized home environments and lifestyles. Methods—This qualitative study was conducted as part of a RCT in which an embedded mixed methods research design was used. Audio-recorded dialogue among patients, family caregivers, and intervention nurses was analyzed using qualitative research methods. Results—Home and lifestyle contexts for managing pain medications included highly individualized home environments, work and recreational activities, personal routines, and family characteristics. Pain medication management processes particularly relevant in these contexts included understanding, organizing, storing, scheduling, remembering, and taking the medications. With the exception of their interactions with the intervention nurses, most study participants had little involvement with clinicians as they worked through these processes. Conclusion—Pain medication management is an ongoing multidimensional process, each step of which has to be mastered by patients and family caregivers when cancer treatment and supportive care is provided on an outpatient basis. Realistic patient- and family-centered skill-building interventions are needed to achieve effective and safe pain medication management in the contexts of individual home environments and lifestyles.