Development and Evaluation of Pain Management Program by Relatives who were Caregivers of Terminally Ill Cancer Patients

Abstract

Objective: to develop and evaluate pain management program by relative caregivers of terminally ill cancer patients. Methods: This study was an action research. The research team comprised of 1) 15 co-researchers; doctors, nurses, and pharmacists. 2) clients including 19 pairs of relative-caregivers and patients with bile duct cancer, lymphoma and others. Phase 1 of the study involved the data collection on Palliative Care Clinic services by observation and interview with research team. Phases 2 of the study were the development of pain management program by caregivers through brainstorming among research team. Phase 3 involved follow-up and evaluation of outcomes including behaviors and attitudes among providers of pain management, drug related problems, knowledge on pain management, perceived competency on pain management and satisfaction among relative caregivers. Results: Phase 1 study revealed that the problems in the area of service provision in the Palliative Care Clinic including service system, different experience among service team, availability of medications, readiness of location, and service team's understanding. The problems of the Clinic according to were readiness among clients to acquire knowledge, attitudes towards morphine use and on service team. Phases 2 found 5 issues affecting the development of pain management program including 1) positive attitudes among providers towards palliative care. 2) adequate knowledge and skills in pain management among providers. 3) Kapanol® was available 4) separate areas for providing care was arranged and 5) improvement of operational guidelines and development of pain management program. The research team defined the responsive activities. The processes of creation and development were performed in 2 cycles, each cycle consisted of 4 sub-steps: planning, implementing plans, observing and reflecting on performance. Phase 3, evaluation of pain management program, found that the service team showed greater knowledge/understanding on concept of palliative care, having a positive attitude towards palliative care. Patients had a decrease in their current pain score, but the minimum pain scores at 24 hours were not changed. The number of drug related problems ware decreased.  Caregivers had a higher level of knowledge and self-efficacy on pain management. Their satisfaction was at a high level. Conclusion: Implementation of action research processes could develop a pain management program by relative caregivers for terminally ill cancer patients, which is appropriate to the hospital context.