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Nurses’ Perspectives on Family Caregiver Medication Management Support and Deprescribing

Tjia, Jennifer MD, MSCE; DeSanto-Madeya, Susan PhD, APRN, CNS; Mazor, Kathleen M. EdD; Han, Paul MD, MA, MPH; Nguyen, Bryan BS; Curran, Tess BS; Gallagher, Julia MD; Clayton, Margaret F. PhD, APRN-BC, FAAN

Journal of Hospice & Palliative Nursing: August 2019 - Volume 21 - Issue 4 - p 312–318
doi: 10.1097/NJH.0000000000000574
Feature Articles

Nurses who care for patients with life-limiting illness operate at the interface of family caregivers (FCGs), patients, and prescribers and are uniquely positioned to guide late-life medication management, including challenging discussions about deprescribing. The study objective was to describe nurses’ perspectives about their role in hospice FCG medication management. Content analysis was used to analyze qualitative interviews with nurses from a parent study exploring views on medication management and deprescribing for advanced cancer patients. Ten home and inpatient hospice nurses, drawn from 3 hospice agencies and their referring hospital systems in New England, were asked to describe current practices of medication management and deprescribing and to evaluate a pilot tool to standardize hospice medication review. Analysis of the 10 interviews revealed that hospice nurses are receptive to a standardized approach for comprehensive medication review upon hospice transition and responded favorably to opportunities to discuss medication discontinuation with FCGs and prescribers. Effective framing for discussions included focus on reducing harmful and nonessential medications and reducing caregiver burden. Results indicate that nurses who care for hospice-eligible and enrolled patients are willing to discuss deprescribing with FCGs and prescribers when conversations are framed around medication harms and their impact on quality of life.

Jennifer Tjia, MD, MSCE, is associate professor of population and quantitative health sciences, University of Massachusetts Medical School, Worcester.

Susan DeSanto-Madeya, PhD, APRN, CNS, is associate clinical professor, Wm. F. Connell School of Nursing, Boston College, Massachusetts.

Kathleen M. Mazor, EdD, is professor, University of Massachusetts Medical School; and associate director, Meyers Primary Care Institute, Worcester, Massachusetts.

Paul Han, MD, MA, MPH, is director, Center for Outcomes Research & Evaluation (CORE), Maine Medical Center, Scarborough; and associate professor of Medicine, Tufts University School of Medicine.

Bryan Nguyen, BS, is candidate for doctor of Medicine, University of Massachusetts Medical School, Worcester.

Tess Curran, BS, is candidate for doctor of Medicine, University of Massachusetts Medical School, Worcester.

Julia Gallagher, MD, is medical director, Home-Based Palliative Care Program, Division of Palliative Care, Massachusetts General Hospital; and instructor in Medicine, Harvard Medical School, Boston, Massachusetts.

Margaret F. Clayton, PhD, APRN-BC, FAAN, is professor, College of Nursing; and auxiliary faculty member, Department of Communication, University of Utah, Salt Lake City.

Address correspondence to Jennifer Tjia, MD, MSCE, University of Massachusetts Medical School, The Albert Sherman Bldg, 368 Plantation St, 6th Floor, Worcester, MA 01605 (

This work was supported by the American Cancer Society/National Palliative Care Resource Center (grant PEP-11-263-01-PCSM).

J.T. serves as a consultant to CVS Health and to CVS Omnicare. The other authors have no conflicts of interest to disclose.

Results of this study have been previously presented, in part, at ASCO Palliative Care in Boston, Massachusetts, October 2014.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Online date: April 29, 2019

© 2019 by The Hospice and Palliative Nurses Association.