Mediating Effect of Family Caregivers' Hesitancy to Use Analgesics on Homecare Cancer Patients' Analgesic Adherence.

Family caregivers play an increasingly critical role in cancer patients' symptom management as the number of cancer patients receiving home care grows. However, there is a lack of research measuring the impact of the family caregivers' hesitancy to use analgesics on analgesic adherence and the resulting influence on patient pain intensity. To examine whether family caregivers' hesitancy to use analgesics is a mediator that influences patient adherence and investigate how analgesic regimen adherence affects pain intensity. This study used a cross-sectional and descriptive design. One hundred seventy-six patient-family caregiver dyads (N = 352) were recruited from one local hospital in southern Taiwan. Instruments included the Short Version of the Barriers Questionnaire-Taiwan, the Morisky Medication Adherence Measure-Taiwan, the Brief Pain Inventory-Chinese, and demographic and illness questionnaires. A one-way analysis of variance and post hoc comparisons were performed to assess the influence of analgesic regimen adherence on pain intensity. Sobel tests were used to examine mediating effects. Family caregivers' hesitancy to use analgesics was a significant mediator between patient barriers to use analgesics and patient analgesic regimen adherence (P < 0.0001). Patients with low and moderate adherence levels reported significantly higher levels of pain severity (F = 3.83, P < 0.05). This study showed that family caregivers' hesitancy to use analgesics was a significant mediator associated with their hesitancy to use analgesics and the patients' analgesic adherence. It is important for health care providers to consider family caregivers' hesitancy to use analgesics when attempting to improve adherence to pain management regimens in clinical practice.

Lee BO ，Liu Y ，Wang YH ，Hsu HT ，Chen CL ，Chou PL ，Hsu WC ... -  《-》

Gender Difference in Cancer Patients' Adherence to Analgesics and Related Outcomes of Pain Management.

Chou PL ，Fang SY ，Sun JL ，Rau KM ，Lee BO ... -  《-》

Assessing analgesic regimen adherence with the Morisky Medication Adherence Measure for Taiwanese patients with cancer pain.

Tzeng JI ，Chang CC ，Chang HJ ，Lin CC ... -  《-》

Development and psychometric testing of a short version of the Barriers Questionnaire-Taiwan form for cancer patients.

A comprehensive assessment of patient hesitancy to use analgesics and accurate knowledge related to the promotion of analgesic adherence is necessary for effective pain management. Unfortunately, there has been a lack of a short and concise questionnaire to assess patients' hesitancy to use analgesics in clinical practice. This paper is a report of the development and psychometric properties of the short version of the Barriers Questionnaire-Taiwan form (S-BQT). This study employed a descriptive design. A convenience sample was recruited from oncology clinics at two medical centers in Taiwan. One hundred and eighty-three (N=183) patients receiving analgesics for cancer pain participated in the study. Instruments included the Barriers Questionnaire-Taiwan form (BQT), the Taiwanese version of the Morisky Medication Adherence Measure-Taiwan form (MMAM-T). Two self-administered questionnaires were performed at the same time, and the ratio of analgesic usage was computed over a two-week period. Reliability was established by calculating Cronbach's α and test-retest reliability. The validity was estimated by construct validity, criterion-related validity, and known group validity. To develop the S-BQT, we used reliability analysis to extract nine items from nine subscales. Internal consistency of the S-BQT was indicated by a Cronbach's alphas score of 0.86. Test-retest reliability was assessed as 0.83 over a two-week interval. Factor analysis revealed two factor structures. Criterion-related validity was examined by correlating the S-BQT score, and MMAM-T score, and the ratio of analgesic use. Known group validity was examined by comparing the S-BQT scores of patients with hesitancy to report pain and take analgesics vs. patients demonstrating no such hesitancy in the previous week. Known group validity was also established by comparing the S-BQT scores among patients with low, moderate, and high adherence to the usage of medication. The S-BQT shows excellent reliability and validity. The use of this instrument can help to improve communication between patients and clinicians regarding the use of analgesics in the management of pain.

Chou PL ，Rau KM ，Lin CC 《-》

Effect of hospice nonprofessional caregiver barriers to pain management on adherence to analgesic administration recommendations and patient outcomes.

Nonprofessional caregivers frequently experience barriers to using analgesics for pain in patients in home hospice settings, and patients in pain may suffer needlessly. For example, caregiver adherence to the administration of analgesics is lower for as-needed (PRN) regimens than for standard around-the-clock regimens. But little is known about the barriers caregivers experience and the effects of those barriers. Accordingly, we determined caregiver barriers to using analgesics to manage the pain of patients in the home hospice care setting, and how such barriers affected caregiver adherence and patient quality of life. To this end, we measured barriers, caregiver adherence to PRN analgesic regimens, and patient health outcomes (pain, depression, quality of life [QoL]). A 3-day longitudinal design was used. We recruited 46 hospice nonprofessional caregiver-patient dyads from a local community hospice agency. Barriers were measured with the Barrier Questionnaire II. Adherence to the PRN analgesic regimen was obtained with a 3-day pain and medication diary. Patient outcome measures included pain intensity, the Hospital Depression Scale, and the Brief Hospice Inventory for QoL. Barrier scores were moderate to low. Caregivers adhered to PRN analgesic regimens approximately 51% of the time. Higher caregiver adherence to PRN analgesic regimens was associated with lower patient pain intensity and higher patient QoL, but not, surprisingly, with barriers to pain management. Longitudinal studies are now needed to identify factors besides caregiver barriers that may unduly lower caregiver adherence to PRN analgesic regimens.

Mayahara M ，Foreman MD ，Wilbur J ，Paice JA ，Fogg LF ... -  《-》