The Role of the Pharmacist on the Palliative Care Team Symptom/Pain Management

Anna K. Morin, PharmD

The Oxford Dictionary defines term palliative as “a medicine or medical treatment that reduces pain without curing its cause” (1). The World Health Organization further defines palliative care as a team-based approach that is patient-, family- and caregiver-centered and focuses on improving quality of life by providing relief from pain and addressing physical, psychosocial, emotional and spiritual needs (2). Palliative care has evolved significantly over the past several decades and can be provided as the main goal of care or in tandem with curative treatment. An interdisciplinary team is required to address the various needs of the patient receiving palliative care, and because medication therapy is usually a core part of a palliative care treatment plan, this team includes pharmacists in both inpatient and outpatient settings. Hospice care is an extension of palliative care that provides compassionate care for people in the last phases of incurable disease so that they may live as fully and comfortably as possible (3).

The role of the pharmacist on the palliative care team, which may also include physicians, nurses, caregivers and spiritual counselors, is diverse and can encompass a number of different roles and responsibilities as part of all aspects of the medication use process. The American Society of Health-System Pharmacists has published guidelines that define the role of the pharmacist engaged in the practice of palliative and hospice care (3). In addition to ensuring the timely provision of medications, pharmacists can play a key role in policy and procedure development, formulary management, and medication therapy management services, including assessment of medication plans, education regarding possible side effects or drugdrug interactions, and the detection and management of drug-related problems. Specialized training or advanced degree programs and postgraduate year 2 (PGY2) residency opportunities are available to train pharmacists to develop, participate in and support comprehensive services for patients in pain and those with palliative care needs (3,4).

Palliative care regimens are highly individualized to meet each patient’s needs. Working as a member of the palliative care team, pharmacists can support the development of individualized treatment regimens and help to optimize both pharmacologic and nonpharmacologic management to improve patient outcomes while reducing costs and unnecessary medications.3,5 As part of their training and responsibilities, pharmacists assess the appropriateness of medication orders and ensure that the patient receives safe and effective care in a timely manner. Many medications can pose administrative challenges for patients with an interruption in oral access, due to nausea and vomiting or other gastrointestinal issues that may develop secondary to many chronic conditions. Pharma- cists can assess and make recommendations for alternative routes of medication administration to improve adherence and overall bioavailability. If necessary, some drugs can be compounded into solutions, topical creams or ointments, or parenteral, rectal, or transdermal dosage formulations (3,5).

A retrospective study evaluating pharmacist intervention and patient outcomes in the palliative care setting found that acceptance of the pharmacist’s recommendation was a significant predictor (p<.001) of desired clinical outcome.6 Recommendations made by pharmacists with experience and training in palliative care included change in dose, medication, route or time of administration and initiating new or discontinuing existing medication therapy. Overall, 90% of recommendations were accepted with 80% of patients achieving better management of symptoms such as anxiety, constipation, depression, nausea and vomiting, and pain (6).

Improving patients’ quality of life and maintaining dignity and comfort during the transition into palliative care are at the center of any care plan. In collaboration with the interdisciplinary team, pharmacists, particularly those with special training or expertise in pain management or palliative care can play a vital role on the palliative care team by serving as patient advocates and managing and improving all aspects of the medication-use process in a variety of patient care settings.

Anna K. Morin, PharmD Associate provost – Worcester/Manchester Massachusetts College of Pharmacy and Health Sciences

REFERENCES:

1. Oxford Dictionary. Palliative. Available at: https://www.oxfordlearnersdictionaries.com/us/ definition/american_english/palliative; accessed Mary 29, 2022

2. World Health Organization. WHO definition of palliative care. Available at: https://web.archive. org/web/20031004221126/http://www.who.int/ cancer/palliative/definition/en/; accessed March 29, 2022.

3. Herndon CM, Nee D, Atayee RS, et al. ASHP guidelines on the pharmacist’s role in palliative and hospice care. Am J Health Syst Pharm. 2016 Sept 1;73(17):1351-67.

4. Palliative Care Pharmacist. Resources: career development. Available at: https://www. palliativepharmacist.org/; accessed March 29, 2022.

5. Demler, TL. Pharmacist involvement in hospice and palliative care. US Pharmacist.2016;41(3):HS2-HS5. 6. Wilson S, Wahler R, Brown J, et al. Impact of pharmacist intervention on clinical outcomes in the palliative care setting. Am J Hosp Palliat Med. 2011;28:316-20.