A community pharmacist medicines optimisation service for patients with advanced cancer pain: a proof of concept study

Abstract

Background Patients with advanced cancer commonly experience pain and it is least controlled in community settings. Community pharmacists in the UK already offer medicines optimisation consultations although not for this patient group. Objective To determine whether medicines consultations for patients with advanced cancer pain are feasible and acceptable. Setting Community-dwelling patients with advanced cancer pain were recruited from primary, secondary and tertiary care using purposive sampling in one UK city. Methods One face-to-face or two telephone delivered medicines optimisation consultations by pharmacists were tested. These were based on services currently delivered in UK community pharmacies. Feedback was obtained from patients and healthcare professionals involved to assess feasibility and acceptability. Main outcome measure Recruitment, acceptability and drug related problems. Results Twenty-three patients, (range 33–88 years) were recruited, 19 completed consultation(s) of whom 17 were receiving palliative care services. Five received face-to-face consultations and 14 by telephone during which 47 drug related problems were identified from 33 consultations (mean 2.5). Advice was provided for 34 drug related problems in 17 patients and referral to other healthcare professionals for 13 in 8 patients, 2 patients had none. Eleven patients returned questionnaires of which 8 (73%) would recommend the consultations to others. Conclusion The consultations were feasible as patients were recruited, retained, consultations delivered, and data collected. Patients found the 20–30 min intervention acceptable, found a self-perceived increase in medicines knowledge and most would recommend it to others. Community pharmacists were willing to carry out these services however they had confidence issues in accessing working knowledge. Most drug related problems were resolved by the pharmacists and even among patients receiving palliative care services there were still issues concerning analgesic management. Pharmacist-conducted medicines consultations demonstrate potential which now needs to be evaluated within a larger study in the future.

Pharmacists’ knowledge, attitude and involvement in palliative care in selected tertiary hospitals in southwestern Nigeria

“…Pharmacists' participation as a member of palliative care team can potentially improve patient medication management knowledge, as well as reduce the risk of non-adherence [14,15,38]. Studies especially in developed countries have identified and reported pharmacists' positive contributions in palliative care [15,[18][19][20][21]39].…”

“…Research indicates that many Correct answer, b = most correct answer, n = number, maximum obtainable score for questions on knowledge of diseases requiring palliative care = 8, and palliative care team composition = 7; % individual score = score obtained by an individual ÷ total obtainable score × 100. Cancer is excluded as a response option because it is well-known that patients with cancer will require palliative care healthcare professionals especially in developing countries are poorly prepared for the complexities of palliative care [21,28,29,33], with the key factors influencing involvement mentioned to include confidence issues, inadequate knowledge and skills as well as attitude, belief and experience [16,19,30,33]. Thus, any palliative care educational programme or training to be designed for pharmacists should largely focus on building knowledge as well as fostering positive attitude and belief about palliative care [30], as this may help to increase involvement in palliative care services [40,41].…”

“…In essence, patients requiring palliative care typically have complicated and high risk medication regimen such as opioids that require frequent adjustment and monitoring [13,14], thereby making the pharmacist a highly desirable member of palliative care team whose contribution can potentially improve the patient medication management and reduce the risk of non-adherence [15][16][17]. Published reports especially from developed countries have identified different roles played by pharmacists in palliative care with benefits and effectiveness of service offered in this context [15][16][17][18][19][20][21][22][23]. However, in most developing countries, palliative care is still an emerging medical specialty that require healthcare providers' contribution and participation [24][25][26][27].…”

“…In addition, the Benchmark for Minimum Academic Standard from the two major regulatory agencies for pharmacy education in Nigeria, that is the National Universities Commission and the Pharmacists Council of Nigeria does not include aspects on palliative care in the curriculum contents. This is in spite of the pharmacists' essential role in medication therapy management especially for patients with complex chronic regimen [15][16][17][18][19][20][21][22][23]. Nevertheless, studies from developed countries have generally identified reasons for low involvement of pharmacists in palliative care to include inadequate knowledge and skills, deficient education and training in palliative care [16,[30][31][32], as well as attitude and belief towards palliative care [16,30,33].…”

Evaluating recruitment methods of patients with advanced cancer: a pragmatic opportunistic comparison

“…All were accredited to provide these pharmacy services; however, specific training was given to recruited pharmacists in pain and palliative care. Further details of the consultation content and findings are available elsewhere.…”