The Role of the Pharmacist in Palliative Care: Tailored End-of-Life Treatment for Patients
Stanley first came into the hospital with non-small cell lung cancer. He successfully completed one round of chemotherapy and spent the next 13 months in high spirits with a rewarding daily life. Eventually, however, the cancer returned, and when home health care was no longer possible, he entered hospice care. At that point, palliative care could have been poor, as it does for so many who end up with bedsores, infected wounds, and worsening pain. However, because he had a health care team committed to his well-being and comfort, Stanley died peacefully with his family around him.
For many patients, end of life care doesn’t always fit into a neat box and in fact, relies on compounded medications developed to fit each patient’s specific needs. Although we often don’t think about it, the role of the pharmacist is of tremendous importance in palliative care. Pharmacists not only offer help to the patient, but also relief to his family and loved ones during a very difficult time.
Why The Role of the Pharmacist Is an Essential Part of Palliative Care
Patients at the end of their lives are often difficult to treat because they have unique conditions that are difficult to diagnose or have competing treatments. Perhaps the patient is elderly and suffers from multiple conditions that all need to be managed but with side effects of the medicines foremost in mind. Maybe the patient is young but suffers from a terminal illness and pain relief is the primary concern. Bedridden patients may be further saddled by ulcerative wounds, systemic infections, catheter-based complications, and depression, all of which can be completely unrelated to the underlying illness. There is no one solution that fits all of these patients, no evidence-based study that tell a patient’s healthcare team exactly how to treat him or her.1
In Stanley’s case, the return of his cancer came with significant pain and a lot of sleeplessness and crankiness because of that. Fortunately, he had a lot of options to help with the pain and its side effects.2 Stanley’s other issues, namely hypertension and heart disease, were treated not with a complex regimen of pills, but with combined oral treatment to reduce the burden on him and his caregivers. None of this was available through commercial pills but through a regimen designed for him through careful consideration of his whole health care team, including his pharmacist.
For some patients, the role of the pharmacist is best realized not just when she fills a specific prescription but when she can offer the patient options to reduce the burden of necessary medications. One part of that is understanding how to manage the side effects of common medications3:
- Mood disorders;
- Secretion issues;
- Infection control;
- Wound care;
- GI distress;
- Fatigue and sleeplessness.
Patient comfort in an end-of-life situation is paramount—for example, it could be that a certain medication causes more pain to a patient than another drug in the same class. Other times, the nutritional deficiencies caused by a certain drug may cause significant problems that can be solved with the right supplements. Still, too, it may be that a patient has difficulty managing a complex regimen with too many medications taken at disruptive times. Especially with cases of home health care, the role of the pharmacist may simply be to listen to a patient’s concerns and suggest changes to her daily drug schedule so that it works for her.
Other patients with more complex conditions may require the expertise of many specialists in an in-care setting—many hospices and home care settings don’t have one expert managing the patient as her primary doctor. In these cases, pharmacists have long been the ideal choice to interact with the patient.4 The role of the pharmacist with these patients lies in:
- Assessing the patient’s medication regimen regularly;
- Educating each member of the health care team on patient’s unique care changes;
- Educating the patient and health care givers on changes made by the pharmacist or other team members;
- Compounding unique non-standard dosages and combinations;
- Communicating financial treatment concerns from the patient to the appropriate parties.
Pharmacists not only have expert medical knowledge about medication guidelines and regulations, but also understand insurance options far better than many practicing physicians have time to deal with. All of this expertise helps address a patient’s physical burdens as well as their emotional ones. It’s time we consider how to optimize the role of the pharmacist to fully utilize these skill sets and help patients who don’t have the energy or ability to do so themselves.
At Pharmaceutica North America, we believe that patients in all stages of life are equally important. Palliative care is difficult on both patients and their loved ones. We are committed to providing you with safe and high-quality compounding materials so that you, and they, can rest assured of receiving the best quality of care. Please contact us today to learn more about how we can help you offer the right type of pain relief and other medications your patients need.
- Compounded drugs of value in outpatient hospice and palliative care practice,” May-Jun 2014, http://www.ncbi.nlm.nih.gov/pubmed/25306765 ↩
- “Getting Help for Cancer Pain,” May 2014, http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-031603.pdf ↩
- “Essential Medicines in Palliative Care,” January 2013, http://www.who.int/selection_medicines/committees/expert/19/applications/PalliativeCare_8_A_R.pdf ↩
- “ASHP Statement on the Pharmacist’s Role in Hospice and Palliative Care,” 2002, http://www.medscape.com/viewarticle/442078_1 ↩