Exploring the Expanded Role of Pharmacists in Advance Care Planning

Abstract

PURPOSE: Advance care planning (ACP) is a clinical skill that can be taught. An opportunity exists to teach how to conduct ACP to clinicians not typically engaged in these conversations to increase the likelihood that patients and caregivers engage in ACP. We conducted a prospective study exploring the feasibility of a pharmacist-led ACP intervention. METHODS: We completed a prospective, single-center study from July 2015 to July 2017. We included patients of age ≥ 18 years with incurable cancer referred to the palliative care clinic. A trained pharmacist led an ACP discussion with the patient and selected proxy. We defined feasibility as completion of ≥ 30 pharmacist-led ACP discussions over the study period. Additionally, we defined an informed healthcare proxy as someone who understood three key end-of-life (EOL) treatment preferences: the patient's personal definition of quality of life, desired resuscitation status, and preferred location of death (in or out of the hospital). Patients were followed until the end of the study or death. For those patients who died, the pharmacist contacted the proxy for follow-up and explored satisfaction with the ACP intervention. RESULTS: Thirty-four patients completed the study. All selected proxies completed the intervention and were able to understand the three EOL preferences. At the time of the patient’s death (n = 20), proxies reported that 66.6% received their preferred resuscitation status and 72.2% died in their preferred location. Proxy satisfaction with the ACP process was 7.6 ± 2.5 (mean ± SD) on a 11-point Likert scale. CONCLUSION: These findings indicate the potential for pharmacists to lead and engage in ACP in the outpatient setting.

Clinical pharmacist in oncology palliative medicine: drug compliance and patient adherence

“…Some clinical studies recommend the early inclusion of a clinical pharmacist. 7 8 Our pilot study tries to approach these problems mainly by proposing the early inclusion of patients in the programme of good pharmacological practice. 15 16 Further research is needed to precisely determine the correct timing of intervention by the clinical pharmacist, the methodology of the intervention and the programme of wider collaboration of the palliative care team.…”

“…5 A clinical pharmacist has in-depth knowledge of drug actions, mechanisms, adverse effects and interactions, thus making them an experienced element in the correct prescription, administration and disposal of therapeutic drugs, providing invaluable advise on the selection of suitable drug forms, for example, enteral, preparation of specially mixed dosage forms, identification of drug duplications and recommend alternative medication. [6][7][8] Moreover, clinical pharmacists must adhere to a professional framework whose conditions are dictated by the legislative and ethical standards followed in most countries, 9 including the Czech Republic. [10][11][12] An oncology palliative care patient is in a fragile state.…”

Enhancing JCO Oncology Practice's Cancer Care Delivery and Quality Improvement Mission With Equity and Value Components

“…The June 2020 issue addressed issues in transgender, sexual, or gender minorities; the July 2020 issue addressed disparities in patients with cancer living in rural settings; and the recent February 2021 issue addressed disparities facing patients with advanced cancers. [4][5][6][7][8][9][10][11][12][13][14][15][16] We are proud to share this May 2021 issue on disparities in cancer care for Black people, which highlights actionable issues in coordination with our annual ASCO meeting and this year's ASCO president, Dr Lori Pierce's theme, "Equity: Every Patient, Every Day, Everywhere." Dr. Pierce's editorial in this special issue, "ASCO's Commitment to Addressing Equity, Diversity and Inclusion of Black Cancer Patients and Survivors" further discusses work ASCO is doing within this theme.…”