adherence, analgesic, caregivers, hospice, opioid, pain management



  1. Mayahara, Masako PhD, RN
  2. Paice, Judith PhD, RN
  3. Wilbur, JoEllen PhD, APN, FAAN
  4. Fogg, Louis PhD
  5. Foreman, Marquis PhD, RN, FAAN


Effective management of pain in hospice is hindered when home (nonprofessional) caregivers do not adhere to prescribed analgesics. The purposes of this study, conducted in home settings, were (1) to identify the quality of the patient's prescribed analgesic medication regimen, (2) to identify the types of as-needed (PRN) analgesic medication errors made by nonprofessional caregivers and the relationship between type of error and patient pain, and (3) to examine the relationships between caregiver adherence to PRN analgesic medication regimens and the patient's reported pain. A 3-day longitudinal design was used. Patient/nonprofessional caregiver dyads (n = 46) were recruited from one home hospice agency. The worst pain experienced on average over 3 days was 6.8 on an 11-point scale, although most patients (87.0%) received adequate analgesics for their pain. At the time the pain was reported, there were analgesic medication errors 49.1% of the time. Giving a sedative rather than the prescribed analgesic and nonadherence to the prescribed PRN analgesic regimens were both related to higher patient pain. To improve pain management outcomes, health care providers need to identify the types of errors made by nonprofessional caregivers and provide them with the tools to help reduce errors.