A new eLearning resource to improve pharmacist engagement with palliative care
An article written by Dr Paul Tait and Leah Robinson
As people approach the end of their lives, they can become vulnerable to medication-related problems (MRPs). [1] The changes to their body and their lowered ability to do activities of daily living impact their experience in managing medicines and contribute to their risk for MRPs. Indeed, those supporting them at home, including caregivers and healthcare professionals, can also be tested by issues relating to the person's medicines. [2,3]
As medicines experts, community-based pharmacists can play a vital role in supporting people living with a life-limiting illness, their caregivers, and their health professionals. Yet, our experience indicates that pharmacists have varying input levels regarding medication management for people with palliative care needs and those who support them. We suspect pharmacists' isolation from the rest of the palliative care team is a factor. [4] Prescriptions often provide clues about a person's needs, and incidental conversations with the person, their carers, or their palliative care team can, too. The literature hints at this: pharmacists cannot always anticipate medication issues, such as which medicines are useful to stock as they are useful in managing terminal phase symptoms. [5] So, there is room for improvement in ensuring pharmacists' active and anticipatory engagement in supporting those with palliative care needs and those supporting them.
But does engagement need to come from pharmacists, too? Can these clues lead to the pharmacist engaging with the person, their carer or their palliative care team? Interestingly, the literature describes the pharmacy profession as willing to support people with palliative care needs. [6] This willingness extends to their carers and their palliative care team. However, pharmacists may need guidance on how and when to engage.
Pharmacists' ability to follow up on these clues may stem from their level of confidence and understanding of the end-of-life trajectory from diagnosis, functional decline, death and bereavement. But even before we can see where the person is in their trajectory, we know that talking about death can be challenging and confronting.
Psychologists use the term ‘death literacy’ to indicate someone's comfort in discussions of various aspects of dying, including the ability to understand and make informed choices about care. [7] While people with professional or lived experience of end-of-life care report higher levels of death literacy, being a healthcare professional on its own does not automatically increase one's death literacy. It’s the experience that matters.
The Pharmaceutical Society of Australia (PSA) has recently released an updated version of the Essential CPE (eCPE) entitled Palliative Care. This eCPE helps guide pharmacists in navigating all aspects of palliative care, from advance care planning through to bereavement support. By completing this activity, pharmacists can feel more confident to identify people approaching the end of their lives and be able to utilise a range of resources in their practice including clinical guidelines, government programs and national tools. They may also better support people with palliative care needs and their carers. This education will also assist pharmacists to learn strategies for effective communication with individuals requiring palliative care support and their carers to help ensure a person-centred approach to care. The PSA believes pharmacist's skills in palliative care can lead to developing valuable professional experiences.
Building death literacy in pharmacists is crucial, especially with the growth of community-based palliative care initiatives; death literacy significantly influences people's behaviour. While education alone cannot replace life experience in caring for individuals with a life-limiting illness, it can help pharmacists identify opportunities to engage with those receiving palliative care, their carers and their palliative care team.
eCPE Palliative Care will be available online from Friday 24th May 2024 for all pharmacists in Australia to access.
Access Essential CPE (eCPE) entitled Palliative Care here.
Author
Dr Paul Tait
Senior Program Manager
SA Virtual Care Service/State Health Coordination Centre
Southern Adelaide Local Health Network
Leah Robinson
Project Manager
Pharmaceutical Society of Australia
Reference
- Cortis LJ. A qualitative study to describe patient‐specific factors that relate to clinical need for and potential to benefit from a medication management service in palliative care. J Pharm Pract Res. 2017 Feb;47(1):34-40.
- Cadogan CA, Murphy M, Boland M, Bennett K, McLean S, Hughes C. Prescribing practices, patterns, and potential harms in patients receiving palliative care: A systematic scoping review. Explor Res Clin Soc Pharm. 2021 Jul 23;3:100050.
- Latif A, Faull C, Ali A, Wilson E, Caswell G, Anderson C, Pollock K. Caring for palliative care patients at home: Medicines management principles and considerations. Pharm J. 2020. Jun 9.
- Bognar J. Palliative care: A primary care pharmacist perspective. Pharmacy (Basel). 2022 Jul 13;10(4):81.
- Tait P, Chakraborty A, Jones K, Tieman J. What Is the community pharmacists' role in supporting older Australians with palliative care needs? Healthcare (Basel). 2021 Apr 21;9(5):489.
- O'Connor M, Fisher C, French L, Halkett G, Jiwa M, Hughes J. Exploring the community pharmacist's role in palliative care: Focusing on the person not just the prescription. Patient Educ Couns. 2011 Jun;83(3):458-64.
- Johansson T, Tishelman C, Eriksson LE, Cohen J, Goliath I. Factors associated with death literacy among Swedish adults: A cross-sectional exploratory study. Palliat Support Care. 2023 May 12:1-11.