Palliate Carer Training Demonstrates High Acceptability and Usability in Simulation

A structured training programme designed to help family carers prepare and administer subcutaneous medications at home demonstrated high acceptability and usability during a mixed-methods user-testing study conducted under simulated conditions. Researchers found that while initial procedural errors occurred during the first training visit, no medication or administration errors were recorded during a subsequent follow-up visit. The findings offer initial evidence regarding how structured training might prepare family members to manage breakthrough symptoms for individuals approaching the end of life who wish to remain at home.

Many people approaching the end of life express a preference to remain and die at home, yet achieving this outcome remains challenging across palliative care systems. A major contributing factor to carer distress and avoidable hospital admissions is delays in symptom control, particularly when managing acute breakthrough symptoms that require subcutaneous medication delivery. Although training family carers to prepare and administer these injections directly has been suggested to address symptom-management delays, healthcare providers and researchers have continued to raise questions regarding whether such interventions are acceptable, usable, and safe for lay individuals.

To investigate these questions, researchers evaluated a structured training programme termed the Palliate intervention. The team designed the programme specifically to support lay carers in the technical preparation and administration of subcutaneous medications within domestic care environments. The trial aimed to systematically evaluate the acceptability, usability, task performance, and user safety associated with the educational intervention using a mixed-methods user-testing design.

The study enrolled 30 participants who were randomised to one of three versions of the Palliate intervention. Investigators scheduled each participant to complete simulated medication-administration scenarios across two distinct observation visits. During these sessions, researchers evaluated overall acceptability using a questionnaire informed by the Theoretical Framework of Acceptability (TFA). Perceived usability was quantitatively captured using the System Usability Scale (SUS), while task efficiency was measured directly via completion time during the simulated procedures.

In addition to questionnaire metrics, the researchers descriptively tracked all observed medication errors, administration errors, documentation errors, and user safety incidents occurring during the trials. Qualitative free-text responses from participants were also collected and analysed using TFA-informed content analysis to explore perceived barriers and opportunities associated with lay medication delivery. Across all intervention versions and testing visits, overall acceptability of the Palliate programme remained consistently high among participants.

The quantitative usability assessments supported these acceptability outcomes, with mean System Usability Scale scores exceeding the established average benchmark of 68 at both testing visits. Statistical evaluation indicated no significant change in usability scores between the two visits. When examining procedural safety and accuracy, researchers recorded errors in 23% of participants at Visit 1; however, no errors were recorded among participants during Visit 2.

Task efficiency showed mixed patterns across the evaluation visits. Median task completion times decreased between visits overall, yet paired analysis revealed significantly longer completion times at Visit 2, with a recorded significance value of p = 0.016. In terms of physical safety, three needle-stick injuries were observed during the testing sessions. The researchers noted that these physical injury incidents were not associated with medication errors.

The authors concluded that under simulated conditions, the Palliate intervention achieved high acceptability and usability, with initial errors subsiding entirely by the second visit. The researchers emphasized that because the evaluation was conducted within simulated user-testing environments, the results directly support undertaking further clinical evaluation of the Palliate programme with family carers in real-world end-of-life care settings.

Subject of Research: Usability and safety of lay carer subcutaneous medication administration in simulated palliative care

Article Title: Acceptability, usability and safety for lay carer preparation and administration of subcutaneous medications at home: a mixed-methods user-testing study

Article References: Sunkersing, D., Shepherd, L., Feather, C., Williams, I., Eastwood, I., Droney, J., Franklin, B. D., Wee, B., O’Hara, L., Darzi, A., & Grailey, K. (2026). Acceptability, usability and safety for lay carer preparation and administration of subcutaneous medications at home: a mixed-methods user-testing study. BMC Palliative Care. https://doi.org/10.1186/s12904-026-02425-1

Image Credits: AI Generated

DOI: 10.1186/s12904-026-02425-1

Keywords: palliative care, subcutaneous medications, lay carers, family caregivers, end of life care, home care, Palliate intervention, user testing, mixed methods, System Usability Scale, Theoretical Framework of Acceptability, medication administration, patient safety, simulation study, breakthrough symptoms, needle stick injuries