For people with a life-limiting illness, there is nothing more precious than the option to spend their remaining time in comfort.

At such a juncture, the goal of their care shifts from prolonging survival to optimising the quality of life, such as reducing pain and cutting medicines that are no longer deemed necessary. The end of life should comprise of as little suffering as possible, and such is the goal of palliative care.

What can a pharmacist do for palliative patients?

As with other healthcare professionals, pharmacists play a unique role in the palliative care team with their equally irreplaceable knowledge in drugs. The core responsibilities of a palliative pharmacist revolve around helping the team to develop treatment plans that are customised to each patient.

These plans may involve pharmacological and non-pharmacological interventions to improve patients' quality of life. Medicine costs will be another important factor for consideration, particularly from the patient's point-of-view. As curative treatments are generally much more costly than palliative care, pharmacists have the power to influence effective utilisation of scarce medicinal resources.

The responsibilities of a palliative pharmacist go beyond patient care. In fact, pharmacists who engage in palliative care have a diverse and complex role in the healthcare continuum.

In addition to providing essential services, palliative pharmacists frequently participate in establishing general principles and best practices that are tailored to local healthcare settings. Other higher level responsibilities also include research and teaching but such roles may not be prevalent in the profession.

Daily job scope of palliative pharmacists

The daily routines of a palliative pharmacist are rather similar to their counterparts in other pharmacy departments, including direct patient care, medication review and reconciliation, education and counselling and administrative work.

The approach to managing palliative patients should be evidence-based and patient-centred. Pharmacists are undeniably well-positioned to serve as an authoritative resource in refining the use of medicine in symptom managements and related care. In particular, pharmacists can generally spot non-essential medications that are either ineffective or futile in the current treatment regimen and can suggest these be withdrawn.

Many medications should be gradually tapered off where abrupt discontinuation may lead to undesirable effects. Pharmacists should exercise caution while recommending any medication discontinuation, and maintain an oversight of the medication-use of their patients.

The management of pain will often be the central theme of the palliative care team. Pharmacists serving in this capacity should routinely ensure that medications for pain management are available as needed, and constantly monitor for the maintenance of such medications.

These pharmacists should also have a thorough understanding of the interplay between complex legislations governing the use of pain medications - typically opioid analgesics - and patients’ need for these drugs. Sometimes, palliative care pharmacists may be involved in preparing specially compounded medications to ensure more personalised care for the terminally ill patient. Morphine syrup is the most commonly prepared formulation in many healthcare facilities.

When the end of life draws near, anxiety and depression are common comorbidities suffered by patients. Under most circumstances, these conditions can be managed by employing appropriate pharmacological treatments, such as anxiolytics and antidepressants.

By carefully assessing the life expectancy of the patient, pharmacists can then outline the most appropriate drug class for use as certain therapeutic options may take weeks to reach the maximum effect.

The indispensable role

The value of a palliative care pharmacist goes beyond his or her knowledge in pharmacotherapy. It is the capacity to bring invaluable and unique perspectives into the often interdisciplinary team.

Although palliative care pharmacy is not a formally recognised specialist field in Malaysia, palliative pharmacists enjoy a distinct position. There are ample challenges and opportunities that await, and there is never a more suitable moment for our fellow pharmacists to endeavour into the field. MIMS

Read more:
3 medication needs of elderly patients that a pharmacist should know
Singapore's MOH to improve palliative care by increasing inpatient beds
Palliative care: Why patients deserve the truth