Palliative care pharmacists possess specialized training and experience that make them invaluable members of the interdisciplinary team (IDT). Many of these pharmacists hold certification in palliative care and may have completed residencies or fellowships in the field. Despite the recommendation from the 2018 fourth edition of the Clinical Practice Guidelines for Quality Palliative Care to include pharmacists on the IDT, only 36 adult palliative care programs reported having a pharmacist on their team in 2018.
The Center to Advance Palliative Care (CAPC) emphasizes that “pharmacists play a unique role in alleviating the suffering of individuals with serious illnesses.” These patients often face complex symptom management challenges, multiple co-morbidities, and polypharmacy. Palliative care pharmacists are experts in identifying and preventing medication-related problems for these intricate cases.
According to CAPC and a recent Hospice News article, palliative care pharmacists contribute their expertise in the following areas:
- Pain and symptom assessment
- Identifying additional drug therapies for unmanaged symptoms or disease progression
- Deprescribing
- Dose adjustments and formulation of special compounded medications
- Opioid conversion
- Assessing medication interactions
- Providing guidance on off-label drug use
- Educating the palliative care team
- Educating patients
- Managing transitions of care and medication reconciliation
Even if a dedicated palliative care pharmacist is not available, there are ways to integrate pharmacy into practice. Some programs utilize triggers to engage the system pharmacist, such as:
- Managing patients with polypharmacy or high-risk medications (e.g., methadone, anticholinergics, multiple opioids, anticoagulants)
- Addressing unmet goals in pain and symptom management
- Assisting with transitions of care
- Monitoring newly prescribed medications or patients on high doses of oral morphine
Building a business case for including pharmacy services involves demonstrating how pharmacists enhance team efficiency and reduce length of stay. As CAPC notes, “Palliative care pharmacists can make valuable contributions to some of the most overburdened teams in the healthcare system, caring for the sickest and most vulnerable patients.”
Training resources for specialty palliative care pharmacists include:
- Iowa College of Pharmacy Palliative Care Certificate
- University of Health Sciences & Pharmacy- St. Louis: Hospice & Palliative Care Certificate Program for Pharmacists
- ASCP
- University of Maryland Palliative Care Certificate, Master’s, Doctoral/PhD
Palliative care certification for pharmacists offered through: Board of Pharmacy Specialties
