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CARer-ADministration of As-Needed Sub-Cutaneous Medication for Breakthrough Symptoms in People Dying at Home : = the CARiAD Feasibility RCT.

Record Type:	Electronic resources : Monograph/item
Title/Author:	CARer-ADministration of As-Needed Sub-Cutaneous Medication for Breakthrough Symptoms in People Dying at Home :/
Reminder of title:	the CARiAD Feasibility RCT.
Author:	Poolman, Marlise.
Description:	1 online resource (697 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 84-02, Section: B.
Contained By:	Dissertations Abstracts International84-02B.
Subject:	Cancer. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=29229206click for full text (PQDT)
ISBN:	9798841532521

CARer-ADministration of As-Needed Sub-Cutaneous Medication for Breakthrough Symptoms in People Dying at Home : = the CARiAD Feasibility RCT.
Poolman, Marlise.

CARer-ADministration of As-Needed Sub-Cutaneous Medication for Breakthrough Symptoms in People Dying at Home :the CARiAD Feasibility RCT. - 1 online resource (697 pages)

Source: Dissertations Abstracts International, Volume: 84-02, Section: B.

Thesis (Ph.D.)--Bangor University (United Kingdom), 2022.

Includes bibliographical references

Background Most people who are dying want to be cared for at home, but only half of them achieve this. The likelihood of a home death often depends on the availability of able and willing lay carers. When people who are dying are unable to take oral medication, injectable medication is used. When top-up medication is required, a healthcare professional travels to the dying person's home, which may delay symptom relief. The administration of subcutaneous medication by lay carers, although not widespread UK practice, has proven to be key in achieving better symptom control for those dying at home in other countries. Objective(s) To determine if carer-administration of as-needed subcutaneous medication for common breakthrough symptoms in people dying at home is feasible and acceptable in the UK, and if it would be feasible to test this intervention in a future definitive randomised controlled trial. Design We conducted a two-arm, parallel-group, individually randomised, open pilot trial of the intervention versus usual care, with a 1 : 1 allocation ratio, using convergent mixed methods. Setting Home-based care without 24/7 paid care provision, in three UK sites. Participants Participants were dyads of adult patients and carers: patients in the last weeks of their life who wished to die at home and lay carers who were willing to be trained to give subcutaneous medication. Strict risk assessment criteria needed to be met before approach, including known history of substance abuse or carer ability to be trained to competency. Intervention Intervention-group carers received training by local nurses using a manualised training package. Main outcome measures Quantitative data were collected at baseline and 6-8 weeks post bereavement and via carer diaries. Interviews with carers and healthcare professionals explored attitudes to, experiences of and preferences for giving subcutaneous medication and experience of trial processes. The main outcomes of interest were feasibility, acceptability, recruitment rates, attrition and selection of the most appropriate outcome measures. Results In total, 40 out of 101 eligible dyads were recruited (39.6%); this met the feasibility criterion of recruiting >30% of eligible dyads. The expected recruitment target (~50 dyads) was not reached, as fewer than expected participants were identified. Although the overall retention rate was 55% (22/40), this was substantially unbalanced [30% (6/20) usual care and 80% (16/20) intervention]. The feasibility criterion of >40% retention was, therefore, considered not met. A total of 12 carers (intervention, n = 10; usual care, n = 2) and 20 healthcare professionals were interviewed. The intervention was considered acceptable, feasible and safe in the small study population. The context of the feasibility study was not ideal, as district nurses were seriously overstretched and unfamiliar with research methods. A disparity in readiness to consider the intervention was demonstrated between carers and healthcare professionals. Findings showed that there were methodological and ethics issues pertaining to researching last days of life care.

Electronic reproduction.
Ann Arbor, Mich. :
ProQuest,
2023

Mode of access: World Wide Web

ISBN: 9798841532521Subjects--Topical Terms:

634186
Cancer.
Index Terms--Genre/Form:

542853
Electronic books.

CARer-ADministration of As-Needed Sub-Cutaneous Medication for Breakthrough Symptoms in People Dying at Home : = the CARiAD Feasibility RCT.
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