Exploring the community pharmacist's role in palliative care: Focusing on the person not just the prescription

Abstract

ObjectivesChanges in health care provision have led to an emphasis on providing end of life care within the home. Community pharmacists are well positioned to provide services to communitybased palliative care patients and carers. MethodsA multiple qualitative case study design was adopted. A total of 16 focus groups and 19 interviews with pharmacists, nurses, general practitioners and carers were undertaken across metropolitan and regional settings in Western Australia, New South Wales, Queensland and Victoria. Data were analysed thematically using a framework that allowed similarities and differences across stakeholder groups and locations to be examined and compared. ResultsThree main themes emerged: Effective communication; Challenges to effective communication; and: Towards best practice, which comprised two themes: Community pharmacists' skills and Community pharmacists' needs. DiscussionA key component of the provision of palliative care was having effective communication skills. Although community pharmacists saw an opportunity to provide interpersonal support, they suggested that they would need to develop better communication skills to fulfil this role. ConclusionThere is clear need for continuing professional development in this area -particularly in communicating effectively and managing strong emotions. Practice implicationsCommunity pharmacists are willing to support palliative care patients and carers but need education, support and resources. Words: 203Key words: community pharmacists, palliative care, focus groups, effective communication, qualitative research 3 Background and objectivesSince the World Health Organisation 1 proposed that primary health should be at the forefront of health systems, patient care has increasingly been moved from hospital to the home. 2 This changing pattern of health care provision has led to an emphasis on providing care in the community to people at the end of life, 3 acknowledging that people prefer to die with the support of family and friends. 4 Achieving a death at home for a palliative care patient is dependent on a range of factors including the availability of skilled support from community based health professionals. 5-7The provision of this skilled support from health care professionals for community based palliative care, however, is complicated by unmet demand for General Practitioner (GP)services and an increasing number of patients with chronic diseases and complex care needs. 8Additionally an ageing population 9 will result in an increased number of people with chronic and/or life-threatening diseases and, consequently, the numbers of patients requiring palliative care. The involvement of community pharmacists in the provision of community based palliative care would seem an appropriate way of alleviating these challenges and supporting end-of-life care in the home.Although not forming the basis of their substantive work, community pharmacists are wellsuited to respond to the palliative care needs of clients, especially as they often have a...

Community Pharmacists' Attitudes Toward Palliative Care: An Australian Nationwide Survey

“…[9][10][11] Community pharmacists from urban and rural communities in Australia reported that they deliver palliative care services infrequently and consequently lack knowledge in this area. 12 Further, community pharmacists who dispense medications to home-based palliative care patients are often unfamiliar with uncommon palliative care medications 13 and often have misconceptions about opioid use. 14 In addition, research suggests that community pharmacists may be reluctant to be involved in palliative care.…”

“…14 In addition, research suggests that community pharmacists may be reluctant to be involved in palliative care. 12 Thus, any training should also work towards fostering positive attitudes towards their involvement in the palliative care interdisciplinary team. 15,16 Nurses' positive attitudes have been found to have a positive impact on both quality of patient care 17 and family participation in care, 18 as well as facilitating learning of factual knowledge.…”

Communicating with palliative care patients nearing the end of life, their families and carers

“…Pharmacists' expert pharmaceutical knowledge and broad skill set -coupled with their widespread accessibility and trusted relationships with patients and carers -mean that they are well suited to better integration within the palliative care team [22], [25] . The pharmacist's role is extending beyond the more traditional elements of dispensing activity and management of minor ailments towards the provision of greater psychosocial support for patients [22], [26] . This creates opportunities for further interaction, not only with patients, but also with loved ones, relatives and carers.…”

“…This is an increasingly relevant topic in light of pharmacists' involvement in palliative care services both nationally and globally [21], [22], [23], [24], [25], [26] .…”

Utility of pharmacists on clinical outcomes of patients in palliative care: A short review

“…Palijativna nega nije ograničena samo na pacijente koji će uskoro umreti, već otpočinje od trenutka postavljanja dijagnoze do smrti. Starenje populacije prozrokuje povećanje broja obolelih od hroničnih/životno ugrožavajućih bolesti, a posledično i broja pacijenata koji zahtevaju palijativnu negu (3). Palijativna nega se sprovodi na svim nivoima zdravstvene zaštite, i u kućnim uslovima (4).…”