Laycarers can confidently prepare and administer subcutaneous injections for palliative care patients at home: A randomized controlled trial

Background: Palliative care patients consistently nominate home as their preferred care environment. This is challenging without support from laycarers, especially if patients require subcutaneously administered symptom relief. Laycarers typically lack confidence with this task and request professional guidance. Aim: To explore differences in laycarers' confidence in administering subcutaneous injections depending upon whether a laycarer, registered nurse or pharmacist prepared injections for subsequent administration by laycarers. Design: Prospective randomized controlled trial with three intervention arms: laycarer prepares, labels and stores injections; registered nurse prepares injections; and pharmacist prepares injections for later administration by laycarer. Setting/participants: In all, 93 laycarers, from 24 urban and rural community services, completed the study. Results: The primary outcome of interest was laycarer confidence with injection administration; analysis of variance revealed no significant differences between the three intervention arms; mean values ranged from 5.9 to 6.1 out of 7 (F(2, 90)=0.50, p=0.61). Comparison of confidence after laycarer preparation versus other (nurse or pharmacist) was not statistically significant (t=0.7, df=90, p=0.49). Averaged over intervention arms, confidence levels increase significantly with injecting experience, from 5.3 to 6.1 (F(1, 75)=47.6, p<0.001). Conclusion: Upskilled laycarers can confidently administer subcutaneous injections for loved ones, regardless of who prepares injections. This finding can improve patient outcomes and potentially decrease unwanted admissions to inpatient facilities.