Palliative care and Pharmacist- Part 3

In the consequent blogs, I will mainly emphasize on the role of the pharmacist in palliatve care and it is aimed at offering the highest possible level of comfort to the patient during the last phase of his life. Technical and excessively prolonged treatment has to be avoided as much as possible, allowing the patient to lead as normal a life as possible.

1. A relationship, based on trust, with the patient and his family
Most of the patients in need of palliative care have already a long lasting relationship, based on trust, with their regular pharmacist. In the difficult circumstances of palliative care, this relationship becomes even stronger. The pharmacist has the full history of the medicines, previously used by the patient, on record. The name of the pharmacist should therefore also be recorded in the file of the patient, along with that of his doctor, ensuring that any additional drug use will be systematically recorded and checked. Patients often move between care settings, for example, hospital, hospice and their own home and it is vital that accurate records of the patient’s medication are transferred between these settings. Pharmacists are usually the only healthcare professional with access to the patient’s complete medication history. The trusting relationship with the pharmacist offers a strong basis for the psychological and social support needed by the patient and his family. During the last phase of life, the patient and his family are confronted with previously unknown and sometimes bewildering aspects. Accepting palliative care as the last option for treatment can be difficult. The family of the patient very often decides to hospitalise the patient when it is not really necessary. The main reason is they are not used to the specific – but very normal - evolutions in the palliative phase of life. On the contrary, home treatment is very often possible, and should be preferred, as it is more comfortable for the patient. For humanitarian reasons, patients wishing to stay with their families for as long as possible should be encouraged to do so, and the pharmacist, along with all other health professionals, can support the patient, and family members, in making the situation more acceptable, and in taking the right decisions.

2. Pharmacotherapeutic advice
Pain and symptom control is the most important item in palliative care. Indeed, one could hardly start with e.g. the psychological and comfort aspects of palliative care, if the patient has a tremendous pain or other symptoms. The pharmacological approach in palliative care is specific and special attention should be paid. The right choice of drug, its dosage, the detection of side effects, interactions, over- or under utilization, (certainly in case of polymedication, as is often the case in palliative care) are important points where communication between the doctor and the pharmacist can be of high importance.

Pharmacist counseling of patients about drug dosage, administration and anticipated side effects can aid compliance. For patients who have difficulty remembering to take their medication at the right time, pharmacists can provide and, where necessary, fill ‘compliance aids’. Side effects or interactions often go undetected. In most cases they are masked, using even more medication, instead of finding the drug that is causing the problem and replacing it with a better suited one. With patients in the last stage of their life, most of them already weakened, to aim at maximum comfort should mean to rationalise and optimise their medication scheme as much as possible. The pharmacist can help to identify best pharmaco-therapeutic solution, also from a financial point of view.