Pharmacist: A vital link in the delivery of palliative care

Mr Premal Mehta, Mumbai

Palliative care focuses on providing relief to patients suffering in pain and from distressing symptoms, and on also providing psychosocial support to the patient and their families too.

A Pharmacists plays a vital role in delivering palliative care in several ways by providing comprehensive pharmaceutical care to those patients who are suffering from life threatening conditions. Through this article, I wish to highlight the crucial role of a pharmacist in a palliative care team.

A pharmacist in a palliative care setting who has the opportunity to work closely with the palliative care team can ensure the timely availability and provision of medications, as medication availability is often a key factor is facilitating the continuity of care for a patient. Pharmacists also play a key role in facilitating a transition of care when patients are either discharged or transferred to other healthcare settings by passing on the necessary information to the other team’s pharmacist. Pharmacists located in either remote locations or away from the treating hospitals can therefore play a key role in ensuring the wellbeing of a patient.

On several instances, it is often seen that palliative care patients are often prescribed multiple medications simultaneously. In such cases, these patients are at an increased risk of drug interactions and drug-related problems. Pharmacists with their domain specific knowledge and expertise are most empowered than any other member of a palliative care team to review prescriptions, detect potential adverse drug reactions and their interactions, and recommend appropriate drug adjustments to suit a particular patient.

If a pharmacist is well integrated in a palliative care team, they will also have the chance to improve their quality of life of their patients as they would have the opportunity to suggest the most suitable medications for effective symptom management by monitoring the patient’s response to therapy.

Another common issue in patients received palliative care is that some of them may experience challenges in swallowing oral medications. Pharmacists in such situations can suggest alternative dosage forms such a liquid form, transdermal patches, suppositories etc. to improve medication compliance.

Many a time, due to various systemic issues, even the best of Doctors are unable to provide the required time for patient education and counselling. A pharmacist will be able to cover this gap by educating and counselling the patient or their caregiver by sharing the correct dosage regime of the prescribed medicines, the administration techniques, and the potential side effects along with its management. This will ensure medication safety. It is also worthwhile to note that pharmacists are some of the most easily accessible members of the healthcare team for a patient or their caregiver, as they can be met without any prior appointments, when they want to seek quick advice regarding medication and other distressing symptoms. An empowered pharmacist will therefore help improve a patient’s overall quality of life by identifying and reporting these incidents to the treating team as needed.

At the point of dispensing medication, pharmacists are often privy to a patient or their caregivers’ financial vulnerability. The pharmacist in such instances can work alongside the social worker to identify and connect these patients and / or their caregivers to the appropriate resources to access the needed support.

At a macro level, pharmacists can also contribute towards improving the quality of palliative care globally. This can be done by increasing the scientific evidence pool by designing and conducting studies to possibly evaluate medication related outcomes, drug interactions, by participating in clinical trials, etc.

Below is one of the many incidents in which I was fortunate to have had the opportunity to improve the quality of life of a patient.

Ms Leela (name changed), a family friend of mine, was diagnosed with CA breast. Though the cancer was detected early through a regular mammogram, she was advised to undergo surgery followed by few cycles of chemotherapy. During this time, Ms Leela had several questions regarding the ongoing treatment, the possible effects of the medications prescribed, the potential long term side effects of the prescribed medication, the duration of treatment etc. She felt it easier to talk to me as I not only had her confidence of being her family friend, but also because she saw me as an important member of the health care team. Being a pharmacist trained in palliative care, I was also able to satisfy her medical queries, provide her with the required counselling, and thereby improve the quality of her life. Ms Leela has now successfully completed her treatment and is back to life with her family.

To conclude, I would like to say that a patient’s dignity and comfort must always be the centre of any care plan by keeping in mind a patient’s unique needs, preference and goals of care. As pharmacists, we must work towards optimising their medication therapy, help in controlling distressing symptoms, and provide the necessary education and support to both the patient and their families, when needed. We must recognise that there has never been a more pressing time for palliative care pharmacists to advocate for their patients by doing all that one can, to make the last days of their patients’ lives as good as possible.

About the Author:

Mr Premal Mehta is a pharmacist with an experience of over 3 decades. His role as the Hon. Secretary of the Andheri Chemist Welfare Association provided him with a unique skillset and perspective which proved to be valuable in his work.

Mr Mehta is passionate about the industry and is very committed to use his knowledge and expertise to help drive innovation and growth in the field of healthcare and palliative care.

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