None listed
Conditions
Brief summary
Palliative care services strive to support patients to die within the setting of their choice, usually home, with optimal symptom control and a pattern of care that is supportive of caregivers. Palliative care professionals appreciate that, due to resource constraints, the likelihood of patients remaining symptomatically well managed at home depends upon input from lay carers, usually family members. This study has been designed to evaluate an intervention that supports and educates caregivers to safely and appropriately administer subcutaneous medications for the purpose of symptom control. The study has two components: 1. To implement a standardised education and support package for lay carers living in urban, regional and rural settings within Queensland and to evaluate that package across the domains of content, efficacy, safety and satisfaction. The package will be evaluated using two lay carer questionnaires. The first will be completed immediately following the delivery of the standardised package. The second will be repeated four weeks after their completion on the trial. The questionnaires will rate the usefulness of the education delivered and resources provided. 2. To identify possible differences in outcomes for lay carers, in terms of confidence, safety, satisfaction, and stress measures with the preparation and injection of subcutaneous medications across three different conditions. I. The lay carer prepares, labels and stores daily breakthrough medications for subsequent injection II. A registered nurse prepares and labels daily breakthrough medications for subsequent storage and injection by lay carers III. A clinical trial pharmacist prepares and labels daily breakthrough medications for subsequent storage and injection by lay carers. Differences in outcomes will be measured using surveys and Likert scales and statistically analysed. In addition, caregivers will be invited to record their experience in a daily diary.
Interventions
Provision of standardised education; Group 1 – Lay carer prepares, labels and stores injections for subsequent administration; Group 2 - Registered nurse prepares, labels and stores injections for subsequent administration by the lay carer.
The visiting registered nurse will deliver the standardised education component face to face, as a one on one session to all lay caregivers participating in the study, occurring once when the need to administer subcutaneous injections becomes apparent. The
Provision of standardised education; Group 1 – Lay carer prepares, labels and stores injections for subsequent administration; Group 2 - Registered nurse prepares, labels and stores injections for subsequent administration by the lay carer. The visiting registered nurse will deliver the standardised education component face to face, as a one on one session to all lay caregivers participating in the study, occurring once when the need to administer subcutaneous injections becomes apparent. The session is expected to last between 30 – 60 minutes. During this time caregivers will be given the opportunity to prepare and practice giving the injections under the supervision of the registered nurse. The topics covered include: a) how to manage symptoms; b) commonly used medications for symptom control; c) access to medications in the community; and d) Safe storage and disposal of medications. At the completion of the session registered nurses will work through a competency checklist with caregivers. The standardised education package includes the following resources: a) a DVD “How to prepare and administer a subcutaneous injection”. This DVD demonstrates aspects of subcutaneous injecting and trouble shooting; b) a booklet “Palliative subcutaneous medication administration: a guide for carers”. This booklet covers topics such as frequently asked questions, importance of symptom control, management of common palliative symptoms, commonly used subcutaneous medications and processes of injecting; c) charts – illustrated step by step guides concerning how to prepare and administer subcutaneous injections; d) colour coded medication labels; e) a daily diary to document aspects of care; and f) a practice demonstration kit that includes a cannula and other equipment involved with subcutaneous injections. Types of injections will depend upon the symptoms displayed by the patient as well as the medications and doses contained within subcutaneous injections. The trial period is determined by the amount of time the lay carer is required to administer subcutaneous medications up to a maximum of 14 days.
Sponsors
Brisbane South Palliative Care Collaborative
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Unpaid lay carers of palliative patients in the home setting who require subcutaneous medications via a subcutaneous cannula. Able to speak, read, write and understand english language.
Exclusion criteria
Lay carers deemed not competent by the registered nurses to prepare and administer subcutaneous injections. Paid carers or lay carers with previous experience in administering subcutaneous medications.
Outcome results
None listed