The Expanding Role of the Pharmacist in Hospice and Palliative Care
Published on 18 June 2020
As often-overlooked members of the hospice and palliative care team, pharmacists who dedicate themselves to this area of practice add immense value through their combination of interdisciplinary knowledge, medication expertise and a focus on compassionate patient care.
"The care of patients with life-limiting disease often includes complex pharmacotherapy regimens that necessitate the inclusion of a pharmacist on the core interdisciplinary team," said Chris Herndon, B.S. '97, Pharm.D. '98, professor of pharmacy practice at Southern Illinois University Edwardsville School of Pharmacy. "As the drug therapy experts, pharmacists are ideally suited to participate in deprescribing efforts and assist in educating the patients and family about the rationale for stopping long-term medications."
Despite their underrepresentation within the first hospice demonstration projects in the United States, pharmacists are becoming recognized as essential members of the care team at the end of a patient's life.
"The need for highly trained pharmacists in hospice and palliative care comes from their unique understanding of the pharmacology of the drugs used in pain and symptom management," Herndon said. "As a patient's prognosis worsens, pharmacists can anticipate drug-related adverse events, drug-drug interactions and drug-disease interactions."
Patients receiving hospice and palliative care often require medications used in unique ways. Pharmacists are especially suited to provide care that is customized to patients' needs.
"Our patients often have multiple comorbid disease states and fluctuating pharmacokinetic parameters," explained Justin Kullgren, Pharm.D., CPE, palliative medicine clinical pharmacy specialist at The Ohio State University. "As the medication expert, the team relies on the pharmacist to ensure the medications will work safely with everything else that is going on with the patient."
Hospice and palliative care pharmacists may be involved in developing symptom management strategies as well as facilitating timely medication administration, monitoring and reporting adverse drug reactions and providing education to patients and their families.
Pharmacists must also possess expertise related to the medications used to alleviate suffering, maintain current knowledge of state and federal controlled substances laws and understand the nuances and distinctions between community-dwelling patients, patients residing in long-term care, assisted-living patients and those in hospice-based facilities.
As the larger health care industry increasingly recognizes the value of pharmacists in providing hospice and palliative care, opportunities have grown for both student pharmacists and those in established careers.
"Pharmacist involvement in hospice and palliative care has been growing significantly over the past 10 years," Herndon explained. "Specialized residency training programs have more than doubled, and several intensive training programs exist, including the Advanced Pain and Palliative Care Training Program offered by the American Society of Health-System Pharmacists Foundation and the Hospice Certification Program offered by St. Louis College of Pharmacy."
"For those wanting a traditional training experience, there is a postgraduate year two in pain and palliative care available," Kullgren said. "For pharmacists already in practice, there are additional resources available to help them gain expertise in this field. The Society of Pain and Palliative Care Pharmacists offers resources to help those caring for patients with palliative care and hospice needs. There are also masters programs and continuing education programs available around the country."
While opportunities are growing and the potential for positive impact is high, hospice and palliative care can present unique challenges as a career path or specialty area. If a student or practicing pharmacist is interested in working in this area, Kullgren recommends shadowing a pharmacist who is already working in palliative or hospice care.
"Those of us working in this specialized area of the profession are eager to share knowledge and help each other," Kullgren said. "That extends to students and professionals who may be considering this as a career path."
"There are so many ways a pharmacist can contribute to the hospice and palliative care team – rarely will help be rejected," Herndon explained. "A strong desire to learn along with a compassionate, patient-centered approach goes a long way."
Continuing Education in Hospice and Palliative Care
To support pharmacists seeking to expand their knowledge in hospice and palliative care, St. Louis College of Pharmacy is pleased to offer an on-demand online continuing education program.
Sessions led by nationally recognized hospice and palliative care experts cover topics including:
- The development and maintenance of a hospice practice
- Working with and communicating within a hospice team
- Managing common challenges in pain management
- Prevalent diseases and disorders present at the end of life
Participants may complete a basic course (11.0 CE hours), advanced course (7.0 CE hours) or a complete certificate program (20.0 CE hours).
Learn more at stlcop.edu/ce.
This story originally appeared in the spring 2020 issue of Script.