Managing cancer pain at home: the decisions and ethical conflicts of patients, family caregivers, and homecare nurses.

The purpose of this paper is to present findings from an exploratory, descriptive study that investigated the experience of managing pain in the home from the perspectives of the patient, the primary family caregiver, and the homecare nurse. In particular, the decisions and ethical conflicts encountered by members of 10 patient-caregiver-nurse triads were studied. Data were collected through in-depth semistructured interviews, and the transcribed interviews were content-analyzed by a multidisciplinary research team. Subjects reported that the use of medications prompted the majority of the decisions and provoked most of the conflicts; however, decisions related to assessment, the future, and how to live with pain were identified as well. Subjects also identified other areas that created conflict, such as spiritual/theological issues, when to tell the truth, and interpersonal relationships. Findings illustrate the importance of understanding the beliefs and values that influence individuals' decisions and conflicts, because discrepant perceptions of the pain experience among patients, caregivers, and nurses can interfere with satisfactory management of pain.