Caring for palliative care patients at home: medicines management principles and considerations

Abstract

Caring for palliative care patients at home: medicines management principles and considerations Standfirst: This article outlines how and when medicine support may be required by palliative care patients and family caregivers, alongside practical steps pharmacy teams can take to deliver supportive care.Palliative care is defined by the National Institute for Health and Care Excellence (NICE) as the active holistic care of patients with advanced, progressive illness, where the management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. With many aspects of palliative care applicable earlier in the course of illness, the main goal is achievement of the best quality of life for patients and their families [1].Access to palliative care is highly uneven and the quality variable, even in high-income countries such as the UK [2]. Only 14% of patients deemed able to benefit from palliative care currently receive it [3,4] while the demand for palliative care is growing. For example, in England and Wales, the need for palliative care is estimated to increase by 25-47% by 2040 [3]. Policy and commissioning drives are required to support excellent care for all patients, including those being care for and dying at home [5]. This is assumed to be the preference for the majority [6], but may not be appropriate for all [7].Patients and family caregivers require appropriate, tailored and rapid access to end of life care. An important aspect of this is support is to better manage medicines, including potent analgesics prescribed to help control pain. The needs of terminally ill patients can change quickly and be unpredictable. Responding to symptoms and advising on care involves a multi-disciplinary whole system approach. Community pharmacists have occupied a marginal role in patient care, being mainly involved in medicine supply. However, current policy promotes a greater involvement of pharmacists in direct care as a means of reducing pressure on GP services and increasing patient access to care. There is great scope for pharmacists to contribute, for example, counselling on medicine use for seriously ill patients who may be homebound, identifying key family members and carers responsible for care, and liaising with other health professionals about prescribing changes, including deprescribing and use of anticipatory medicines, close to the end of life. This article aims to consider how pharmacists can better support terminally ill patients, and the family caregivers who support them, to manage medicines at home. Specifically, it will highlight the day-to-day challenges patients and family caregivers face and offer practical information and ways that medicines optimisation can be applied to support palliative care patients being cared in the community setting.

Preface: The Role of Pharmacists in Palliative and End of Life Care

“…The current and potential role of pharmacists in palliative care and end of life care is rarely recognised by patients or health professionals [14][15][16][17][18]. The scope for pharmacy, while not without potential barriers, is considerable, especially in light of the COVID-19 pandemic [16,19,20].…”

“…The current and potential role of pharmacists in palliative care and end of life care is rarely recognised by patients or health professionals [14][15][16][17][18]. The scope for pharmacy, while not without potential barriers, is considerable, especially in light of the COVID-19 pandemic [16,19,20]. The Special Issue aims to move the discussion beyond the potential for pharmacists to be part of palliative care provision by drawing together illustrations of good practice and highlighting the ways in which pharmacists are positively contributing to palliative and end of life care in both the hospital and home environments.…”