Journal of Palliative Care & Medicine
Open Access

In this article, we delve into the vital role of pharmacists in palliative and end of life care, shedding light on how they can significantly influence the quality of care provided. We explore diverse aspects, from the integration of pharmacists into palliative care teams to the accessibility of medications, supporting patients both in hospital and at home, and the types of medications employed during end of life [1]. As advancements in technology, pharmaceuticals, and health promotion lead to longer life expectancies, we find ourselves living with multiple co-morbidities at older ages, ultimately shaping our experiences during palliative and end of life care [2,3]. Although life expectancy in the UK has almost doubled since 1841, the understanding of medication use in this context remains limited. Research focused on older age and dementia reveals the challenges individuals face in managing complex medication regimens with multiple medications and routes of administration [4-8]. In the last year of life, the majority of care is often provided in a home environment, placing increasing responsibilities on family members to manage medications and provide care and support. Managing medications at home becomes a significant task, accompanied by emotional distress, daily practical living challenges, and exhaustion while caring for a dying loved one [10-13]. A growing body of literature emphasizes the complexities of medication provision and management in the community, highlighting the immense work and organization involved [10]. As we explore the impact of pharmacists in palliative and end of life care, it becomes evident that their expertise can play a pivotal role in alleviating medication-related burdens and improving the overall quality of care during these critical stages of life.

Pharmacists' significance in palliative care and end of life care is often underestimated by both patients and healthcare professionals, as evidenced by several studies [14-18]. However, there exists substantial potential for the pharmacy sector to make a meaningful impact, despite certain barriers, especially in light of the COVID-19 pandemic [16,19,20]. This seeks to transcend the discussion surrounding the potential role of pharmacists in palliative care and instead focuses on showcasing exemplary practices and highlighting the valuable contributions of pharmacists to palliative and end of life care in both hospital and home settings. In recent years, there has been growing recognition of the vital role pharmacists can play in palliative care and end of life care. Despite this, the full potential of pharmacists in these critical areas remains largely unrecognized by both patients and other healthcare professionals. However, several studies and research papers have shed light on the immense value pharmacists bring to the table in enhancing the quality of care and ensuring optimal medication management during the challenging stages of palliative and end of life care [14-18]. The scope for pharmacy involvement in palliative and end of life care is vast, offering various opportunities to improve patient outcomes and experiences. Pharmacists possess unique expertise in medication management, drug interactions, and dosage adjustments, all of which are particularly crucial when patients are dealing with complex medication regimens, multiple comorbidities, and challenging symptoms. Their involvement in the palliative care team can ensure that patients receive appropriate and personalized pharmacological support to alleviate symptoms, enhance comfort, and optimize medication use. The ongoing COVID-19 pandemic has further highlighted the significance of pharmacists in providing palliative care. As healthcare systems grapple with increased demands and challenges, pharmacists have demonstrated their resilience and adaptability in ensuring uninterrupted medication access, medication safety, and telehealth consultations for patients receiving palliative and end of life care. The pandemic has accelerated the need for innovative approaches to care delivery, and pharmacists have been at the forefront, leveraging technology and remote services to ensure patients receive the support they need, even in the comfort of their homes [19,20].

The aim is to break through the misconceptions surrounding pharmacists' roles in palliative care and end of life care by showcasing real-world examples of good practice. By collating illustrations of successful pharmacist involvement and highlighting their positive contributions, this seeks to elevate the status of pharmacists in these vital healthcare domains. It emphasizes that pharmacists are not only integral members of the palliative care team but can also be transformative forces in providing holistic care to patients, addressing medicationrelated challenges, and promoting overall well-being. Moreover, it seeks to emphasize that pharmacists' impact extends beyond hospital settings and into the home environment, where the majority of palliative care is provided. Families and caregivers often face significant challenges in managing medications, and pharmacists can offer invaluable support by educating them about proper administration, potential side effects, and ensuring medication adherence, all while being sensitive to the emotional and psychological aspects of end of life care. By bringing these experiences to the forefront, the aim is to inspire further integration of pharmacists in palliative care teams and promote collaborative efforts in delivering comprehensive and compassionate care to patients and their families.

Conclusion

In conclusion, pharmacists play a pivotal role in palliative care and end of life care, contributing significantly to improving patient outcomes and experiences. Despite the existing barriers, their involvement can be transformative in ensuring optimal medication management and addressing medication-related challenges during these critical stages of care. It serves as a platform to shine a spotlight on the positive impact of pharmacists, presenting exemplary practices and emphasizing their potential in both hospital and home care settings. By recognizing and celebrating these contributions, it is hoped that pharmacists will gain the recognition they deserve and become essential partners in delivering holistic and patient-centered palliative and end of life care.

Acknowledgement

Not applicable.

Conflict of interest

Author declares no conflict of interest.

1. Raleigh V (2020) What Is Happening to Life Expectancy in the UK? 2020.
2. OECD (2009) Ageing societies. In OECD Factbook 2009: Economic, Environmental and Social Statistics; OECD Publishing, Paris, France.

Google Scholar, Crossref

3. Turner M, King C, Milligan C, Thomas C, Brearley SG, et al. (2016) Caring for a dying spouse at the end of life: ‘It’s one of the things you volunteer for when you get married’: A qualitative study of the oldest carers’ experiences. Age Ageing 45:421-426.

Indexed at, Google Scholar, Crossref

4. Maidment ID, Aston L, Moutela T, Fox CG, Hilton A (2017) A qualitative study exploring medication management in people with dementia living in the community and the potential role of the community pharmacist. Health Expect 20:929-942.

Indexed at, Google Scholar, Crossref

5. Notenboom K, Beers E, van Riet-Nales D, Egberts T, Leufkens H, et al. (2014) Practical Problems with Medication Use that Older People Experience: A Qualitative Study. J Am Geriatr Soc 62:2339-2344.

Indexed at, Google Scholar, Crossref

6. Orlu-Gul M, Raimi-Abraham B, Jamieson E, Wei L, Murray M, et al. (2014) Public engagement workshop: How to improve medicines for older people? Int J Pharm 459:65-69.

Indexed at, Google Scholar, Crossref

7. Currow DC, Stevenson JP, Abernethy AP, Plummer J, Shelby-Jones TM (2007) Prescribing in Palliative Care as Death Approaches. JAGS 55:590-595.

Indexed at, Google Scholar, Crossref

8. Sheehy-Skeffington B, McLean S, Bramwell M, O’Leary N, O’Gorman A (2014) Caregivers Experiences of Managing Medications for Palliative Care Patients at the End of Life: A Qualitative Study. Am J Hosp Palliat Med 31:148-154.

Indexed at, Google Scholar, Crossref

9. Wilson E, Caswell G, Turner N, Pollock K (2018) Managing Medicines for Patients Dying at Home: A Review of Family Caregivers’ Experiences. J Pain Symptom Manag 56:962-974.

Indexed at, Google Scholar, Crossref

10. Pollock K, Wilson E, Caswell G, Latif A, Caswell A, et al. (2021) First Look Summary: Managing Medicine for Patients with Serious Illness Being Cared for at Home. NIHR.

Google Scholar

11. Ogi M, Campling N, Birtwistle J, Richardson A, Bennett MI, et al. (2021) Community access to palliative care medicines-patient and professional experience: Systematic review and narrative synthesis. BMJ Supportive Palliat Care 2021.

Indexed at, Google Scholar, Crossref

12. Latter S, Campling N, Birtwistle J, Richardson A, Bennett MI, et al. (2020) Supporting patient access to medicines in community palliative care: On-line survey of health professionals’ practice, perceived effectiveness and influencing factors. BMC Palliat Care 19:148.

Indexed at, Google Scholar, Crossref

13. Bowers B, Ryan R, Kuhn I, Barclay S (2018) Anticipatory prescribing of injectable medications for adults at the end of life in the community: A systematic literature review and narrative synthesis. Palliat Med 33:160-177.

Indexed at, Google Scholar, Crossref

14. O’Connor M, Pugh J, Moyez J, Hughes J, Fisher C (2011) The palliative care interdisciplinary team: Where is the community pharmacist? J Palliat Med 14:7-11.

Indexed at, Google Scholar, Crossref

15. Wilson E, Caswell G, Latif A, Anderson C, Faull C et al. (2020) An exploration of the experiences of professionals supporting patients approaching the end of life in medicines management at home. A qualitative study. BMC Palliat Care 19:66.

Indexed at, Google Scholar, Crossref

16. Latif A, Faull C, Wilson E, Caswell G, Ali A (2020) Managing medicines for patients with palliative care needs being cared for at home: Insights for community pharmacy professionals. Pharm J.

Google Scholar, Crossref

17. Savage I, Blenkinsopp A, Closs SJ, Bennet MI (2013) ‘Like doing a jigsaw with half the parts missing’: Community pharmacists and the management of cancer pain in the community. Int J Pharm Pract 21:151-160.

Indexed at, Google Scholar, Crossref

18. Krzyżaniak N, Pawłowska I, Bajorek B (2016) An overview of pharmacist roles in palliative care: A worldwide comparison. Palliat Med Pract 10:160-173.

Google Scholar

19. Tait P, Swetenham K (2014) Forging an advanced practice role for pharmacists in palliative care. Pharm Pract Res 44:120-124.

Google Scholar, Crossref

20. Kuruvilla L, Weeks G, Eastman P, George J (2018) Medication management for community palliative care patients and the role of a specialist palliative care pharmacist: A qualitative exploration of consumer and health care professional perspectives. Palliat Med 32:1369-1377.

Indexed at, Google Scholar, Crossref