The study highlights the variable understanding of ACS and the lack of standardised assessment and management tools amongst staff in an acute hospital setting. This is likely to lead to inconsistent, and perhaps inadequate, care of patients with palliative care needs. Greater awareness and basic pathways of care may help to improve the experience of ACS for patients with cancer.

Conclusions. This small-scale study provides useful insights into the attitudes of these pharmacists towards EHC, the impact of increased availability of the drug, and the type of women who they believed would use EHC. IntroductionIn the United Kingdom (UK) the government is committed to reducing unwanted pregnancies and terminations, notably, but not exclusively, amongst teenage women. Although the teenage pregnancy rate is acknowledged as one of the highest in Europe, 1 the termination rate is also high amongst older women, with almost half (48%) of all terminations occurring in the 20-29 age group. 2 Effective access to emergency hormonal contraception (EHC), which can be taken within 72 hours of unprotected intercourse, is likely to be an important part of any sexual health strategy to reduce unwanted conceptions. The drug levonorgestrel (prescription-only brand name, Levonelle-2 ® ) has recently been deregulated by the UK government, at the manufacturer's request, from a prescription-only medicine (POM) to a pharmacy (P) status, thus allowing over-thecounter sales in pharmacies to women aged 16 years or over.By increasing access to emergency contraception through pharmacies, it is hoped that more women will use this oftenneglected form of contraception.3 Previous concerns about existing provision of EHC have centred on the non-uniformity of provision; difficulties obtaining an appointment with a general practitioner (GP); judgmental and sometimes hostile attitudes of health professionals, and the restricted opening hours of many family planning clinics and GP surgeries. 4 The main professional organisations representing GPs, pharmacists and family planning professionals all supported the deregulation of EHC; indeed the British Medical Association (BMA) has criticised the government for not allowing sales of the drug to under 16s. 5 However, few studies have sought to investigate the views of community pharmacists towards this form of contraception. [6][7][8] A number of drugs have been deregulated from POM to P medicine status in the UK since 1992. 9 There have been calls for deregulation of EHC for several years, and this is seen as one aspect of the drive to reduce termination and pregnancy rates in the UK.In 1999 the manufacturers of Levonelle-2 ® , Schering Healthcare, applied to the Medicines Control Agency (MCA) for a change in the product licence from POM to a P medicine. In the UK, the MCA is the organisation with the authority to licence medicines for human use and to determine their availability status. At the same time, Health Action Zones in Manchester and the London Borough of Lambeth and three primary care groups in Derbyshire established pilot schemes to provide EHC (initially PC4 ® then subsequently Levonelle-2 ® ) under patient group directions (PGD). 10 A PGD is defined as 'a written direction, signed by a doctor or dentist and by a pharmacist, relating to supply and administration only of a prescription-only medicine or pharmacy medicine to persons generally, subject to any exclusions tha...

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There is no apparent detriment to INR control when pharmacist management is compared with that of GPs. The overall proportion of INR estimations within the prescribed range is greater for pharmacists than for GPs and the interval between tests is longer for pharmacists compared with GPs.

ACS in patients with cancer is associated with a significant number of active symptoms, many unmanaged by prescription medication. The potential for standardised assessment and management is raised.