Palliative Care: Understanding Its Importance and Role of Pharmacists

This comprehensive overview of palliative care is presented by Sarah Craig and Daniel Monnery, both experts in the field, aimed at enhancing knowledge about the principles, the pharmacist's pivotal role, symptom management, and the complexity of care strategies employed in palliative settings.

Learning Outcomes

Understanding the essence of palliative care and its significance in patient management.
Acknowledging the role pharmacists play in palliative care.
Identifying common symptoms managed in palliative care and their treatments.
Comprehending anticipatory medicines and their prescription criteria.
Understanding continuous subcutaneous infusions and their applications.
Dealing with syringe compatibility issues within palliative care.

Introduction

This lecture aims to provide a rapid yet thorough overview of palliative care. It's important to note that palliative care extends beyond oncology, encompassing various aspects that will be briefly touched on during the session.

Prevalence and Demand for Palliative Care

Statistics indicate that 90% of individuals who died in the UK between 2017 and 2021 would have greatly benefited from palliative care services. The demand for these services is projected to escalate significantly; by 2048, it is estimated that over 730,000 individuals annually will have palliative care needs, influenced by an increasing population and advancements in early diagnosis and treatment that enable patients with severe illnesses to live longer.

Challenges in Palliative Care

Despite the rising demand, it is concerning that 1 in 4 individuals in the UK currently die without the necessary support and care at the end of life, highlighting a critical need for systemic changes within palliative care frameworks.

The Pharmacist's Role in Palliative Care

Pharmacists hold a fundamental position within the multidisciplinary team (MDT) that supports patients with palliative care needs across various healthcare settings, including primary, secondary, and tertiary care. Their responsibilities include:

Facilitating the supply of drugs needed for symptom management.
Ensuring safe and effective drug usage.
Making deprescribing recommendations where appropriate.
Providing guidance on drug administration.
Involvement in drug procurement and use of continuous subcutaneous infusions.
Offering psychosocial support, working closely within the MDT.

Principles of Palliative Care

Palliative care is characterized by its key principles, which emphasize holistic relief from distressing symptoms, acknowledgment of dying as a natural part of life, and integration of psychological and spiritual aspects of care. It aims to enhance the quality of life for patients and their families and is applicable early during the course of illness, even alongside curative treatments.

Common Symptoms and Management Strategies

Palliative care addresses a variety of symptoms, including:

Excess secretions
Pain
Restlessness
Breathlessness
Nausea and vomiting
Confusion

Pain Management

Pain is a predominant symptom managed in palliative care, categorized into four types:

Nociceptive Pain: Contains somatic (deep and surface) and visceral pain stemming from tissue damage.
Neuropathic Pain: Results from nervous system injury, typically presenting as severe burning or tingling sensations.
Bone Pain: A dull, localized pain often exacerbated by movement, typically seen in metastatic cancer cases.
Psychological Pain: Psychological distress can amplify pain experiences, necessitating interventions like cognitive-behavioral therapy.

The World Health Organization (WHO) recommends a three-step analgesic ladder for pain management, starting from non-opioid medications, progressing to weak opioids, and finally to strong opioids for severe pain.

Nausea and Vomiting

About 50-60% of patients with advanced cancer experience nausea, which may be exacerbated at the end of life, necessitating targeted management based on the underlying cause and pathways involved.

Breathlessness Management

Breathlessness affects a majority of patients with serious illnesses. Management combines pharmacological and non-pharmacological interventions, focusing on alleviating any reversible causes.

Excess Secretions

Noisy secretions can cause distress towards the end of life, necessitating pharmacological interventions such as glycopyrronium.

Anticipatory Medicines

Anticipatory medicines are crucial as they are prescribed in anticipation of symptoms that may arise towards the end of life. These medications ensure rapid symptom relief when distressing symptoms appear, based on the individual needs of patients.

Continuous Subcutaneous Infusions (CSCI)

CSCIs facilitate continuous medication delivery for symptom management, overcoming barriers posed by oral administration due to symptoms like nausea or swallowing difficulty. Pharmacists must ensure the prescribed medications are compatible for safe use.

Dealing with Syringe Compatibility Queries

It is paramount to assess drug compatibility, focusing on the concentration of each drug, the diluent used, and other factors influencing compatibility. When faced with compatibility queries, pharmacists can consult various resources, raising concerns with the palliative care team when necessary.

Conclusion

Palliative care extends beyond end-of-life considerations, significantly addressing symptom management which can profoundly impact a patient's quality of life. Pharmacists play a critical role in supporting palliative care through various interventions and their expertise in medication management.

Further Resources

Pallaborative Northwest Clinical Standards and Guidelines
Scottish Palliative Care Guidelines
The Syringe Driver: Continuous subcutaneous infusions in palliative care by Andrew Dickman and Jennifer Schneider (4th edition)
NICE Guideline 31: Care of dying adults in the last days of life
NICE Guideline 142: End of life care for adults: service delivery
NICE Clinical Guideline 140: Palliative care for adults: strong opioids for pain relief
Palliative Care Formulary by Andrew Wilcock, Paul Howard and Sarah Charlesworth (8th edition)

Palliative Care Overview and Pharmacist Role

Palliative Care Overview and Pharmacist Role