What role do pharmacists play in palliative care?

At some stage in their lives, most Australians will need the assistance of palliative care services, whether as a patient, family member or carer. Pharmacists are an important part of the multidisciplinary teams that provide this support.

The recent National Palliative Care Week aimed to raise awareness and understanding about palliative care in the community, which includes care and treatment that is designed to improve the quality of life of patients and their families facing life-limiting illness.

‘Importantly, care is multi-disciplinary, and all pharmacists have a role,’ said South Australian pharmacist Paul Tait MPS, who is conducting a research project into palliative care at Flinders University.

‘In many ways, they are unseen essential workers, caring for those in need during a critical time.’

End-of-life care, in which pharmacists also have a role, is delivered to patients likely to die within the next 12 months, but can include those whose death will occur in a few hours or days.

Providing expert care

Lorna Chess-Williams MPS is an expert palliative care pharmacist at Gold Coast Hospital and Health Service, where she is a vital member of a team that includes medical practitioners, social workers, nurses and psychologists in an in-patient setting.

Her role also includes providing advice to residential aged care facilities and to patients receiving palliative care in the community through outpatient clinics and via telehealth as part of a rural and remote outreach service.

Palliative care pharmacists have an in-depth knowledge of drug pharmacokinetics and pharmacodynamics, said Ms Chess-Williams, as well as expertise in the practical aspects of prescribing, such as the Pharmaceutical Benefits Scheme and hospital availability of medicines. They also help facilitate medicine access through community pharmacies.

‘Palliative care can be particularly challenging as patients and their families are having to deal with very strong emotions,’ she said.

‘As a pharmacist it is important to communicate well and give the patient/carer time to talk about their medicine issues.’

During the COVID-19 pandemic, Ms Chess-Williams has helped adapt out-patient clinics from in-person consultations to videoconferencing.

‘The use of technology has allowed us to continue to provide a limited service to people receiving palliative care in the community,’ she said.

‘From a pharmacist perspective, there were advantages in that the patient had access to their medicine for review available at home.’

All pharmacists can provide care

For community pharmacists, Mr Tait hopes a new survey will gauge their understanding of palliative care and their role in it, as well as determine practice changes required to improve care.

The survey is being conducted by Flinders University as a member of the federally-funded End of Life Directions for Aged Care (ELDAC) consortium of national universities and health agencies.

Mr Tait said ELDAC had developed a framework around good palliative care that included advance care planning, assessing palliative care needs, recognising end of life, responding to deterioration and managing dying.

‘We are trying to understand where pharmacists fit into that framework and what sort of resources they could lean on to help them better manage care,’ he said.

‘All pharmacists are part of a workforce supporting people, not just in hospitals, but patients and carers in their homes to be confident and upskilled.’

PSA’s South Australia State Manager Helen Stone MPS welcomed two grants from the state government under the Palliative Care 2020 Grants Program, which will be used to further assist pharmacists.

This includes funding a palliative care masterclass to educate pharmacists on medicines management for end-of-life care.

‘The second grant will be used to establish a palliative care pharmacist in aged care program and articulate a framework for the role of the palliative care pharmacist in aged care,’ Ms Stone said.

‘The project aims to establish a network and communication pathway between specialist palliative care pharmacists, aged care pharmacists, community pharmacists and GPs.’

PSA has also teamed up with the Adelaide Primary Health Network to provide the Palliative Care Access to core Medicines project, which that aims to support palliative care in the community by improving access to vital medicines at end of life.