Managing medications at home for patients with advanced cancer: a qualitative study

Background: Issues pertaining to end of life cancer care, particularly the ability to be cared for and to die at home, affect many patients and their families throughout Northern Ireland.

Purpose: To identify the key issues for patients with advanced cancer, and their carers, in the management of medications at home.

Methods: Theoretical sampling was used to recruit patients with advanced cancer and their carers from three day hospices across Northern Ireland. Semi-structured interviews were conducted using an interview guide developed through literature review and discussion by the research team. Participants provided written informed consent. Interviews were transcribed verbatim and analysed using grounded theory analysis. Recruitment continued until no novel themes emerged.

Results: Eleven patients and three carers participated in interviews between June 2017 and March 2018. Six themes emerged: transfer and communication between care settings; medication review and adherence; social influences; medication management; and pharmacy involvement. Difficulties obtaining medication were frequently reported. While patients had varying opinions of how much medication related information they needed, carers all expressed a need for more information. Medication reviews were only offered if requested and despite the frequent use of compliance aids, adherence appeared to be an issue. Participants rarely contacted the pharmacist for advice.

Conclusion: Patients with advanced cancer and their carers struggle with the task of managing medications. Community pharmacists’ role in supporting patient and carers in the home setting could be enhanced.