Palliative Care Is Everyone's Business, Including Pharmacists

Cortis, Lauren J.; Anderson, Claire

doi:10.5688/ajpe77221

Cited by 11 publications

(9 citation statements)

References 6 publications

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“…Some reduction in long-term medicines tends to be offset by prescribing of new medicines to control symptoms (such as pain, nausea and agitation) as the end of life approaches. 22,58,59 CONTEXT AND INTRODUCTION NIHR Journals Library www.journalslibrary.nihr.ac.uk…”

Section: Discussionmentioning

confidence: 99%

Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study

Pollock

Wilson

Caswell

et al. 2021

Health Serv Deliv Res

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Background More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services. Objective To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting. Design A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops. Setting This took place in Nottinghamshire and Leicestershire, UK. Results As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care. Limitations The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned. Conclusions The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life. Future work Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 99%

Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study

Pollock

Wilson

Caswell

et al. 2021

Health Serv Deliv Res

Self Cite

View full text Add to dashboard Cite

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“…This multipronged approach for all students is novel and aligns with the need for palliative care education for all students, as recently highlighted in pharmacy education. This educational need mirrors the growing need for palliative care pharmacists and the diverse roles that pharmacists may play in this setting 19‐21 . The role of the palliative care pharmacist includes direct patient care, counseling, patient advocacy, and education 21 .…”

Section: Discussionmentioning

confidence: 97%

A multipronged approach to teaching end‐of‐life care to student pharmacists

Howard

Atanda

Gaviola

2021

J Am Coll Clin Pharm

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IntroductionStudent pharmacists are typically taught topics regarding end‐of‐life care through required didactic courses or professional electives. Important topics such as death and dying and empathetic communication skills surrounding difficult end‐of‐life care discussions are often unaddressed. To best equip students with the skills needed for practice, it is important to expose them to multiple aspects of end‐of‐life care.ObjectiveTo evaluate the impact of a coordinated multipronged teaching approach including a workshop‐based activity on student pharmacists' initial perceptions, knowledge, and confidence related to end‐of‐life care.MethodsWithin our curriculum, topics surrounding end‐of‐life care have historically focused on pharmacotherapy with minimal time spent on conversation practice and empathy development. In spring 2019, we conducted an all‐day session incorporating various teaching approaches (ie, didactic lecture, ethical debate, Death over Dinner workshop) to prepare students to engage in these difficult discussions. A 21‐item survey, administered at three time points (pre‐, mid‐, post‐), assessed student pharmacists across three domains: Perceptions, Confidence, and Knowledge surrounding end‐of‐life.ResultsNinety‐six students participated in the session with 91% completing the pre‐survey, 69% completing the midpoint, and 59% completing the post‐survey. Forty‐nine (51%) completed matched survey responses across all time points. There was significant improvement in 13 (62%) of the survey items across three domains: 43% of items related to perception, 43% knowledge, and 100% confidence.ConclusionsA multipronged, workshop‐based approach to teaching end‐of‐life care to facilitate difficult discussions surrounding death improved perceptions, confidence, and perceived knowledge among student pharmacists. This approach provided numerous avenues for students to learn and develop empathetic communication skills surrounding end‐of‐life care and represents an innovative approach to prepare students for conversations surrounding death and dying within their professional and personal lives.

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“…O sucesso terapêutico depende dessa compreensão por parte do paciente e seus familiares. O farmacêutico se insere nesse cuidado quando realiza revisão de prescrição, capacitação da equipe de saúde e dos cuidadores, faz ajuste e conversão de dosagens e participa das equipes multidisciplinares 15 . Em estudo realizado por Hussainy et al na Austrália, a inclusão de farmacêuticos nas equipes aumentou o conhecimento relacionado a medicamentos por parte da equipe de CP e dos pacientes, melhorando o manejo das prescrições e reduzindo erros relacionados 16 .…”

Section: Discussionunclassified