Person- and carer-centred palliative care: consensus for the pharmacy profession

Abstract

In the previous issue of the Journal of Pharmacy Practice and Research, the Society of Hospital Pharmacists of Australia (SHPA) Standard of practice in palliative care for pharmacy services was published.¹ This Standard describes current best practice for the provision of palliative care pharmacy services and demonstrates the depth and breadth of these services that have continued to evolve over the recent decade. This includes describing essential and emerging services and challenges the profession to strive to provide emerging services, in addition to essential services wherever possible. This is indeed a challenge when these services are provided in non-specialist and specialist palliative care settings by individual practitioners with varying degrees of experience and expertise. This professional Practice Standard sets the scene and provides guidance to pharmacists within palliative care interdisciplinary teams, through to those working in more generalist roles in settings with clinicians without palliative expertise and, most importantly, entrenches the essence of the palliative care approach in the profession.

Fundamental to this approach is the description within the Standard that everyone shares a fundamental right to safe and high-quality health care, including palliative care services, as is clearly prioritised in the Australian Charter of Healthcare Rights.² However, there is clear evidence both internationally and within Australia that many patients who would benefit from palliative care service unfortunately do not have access to these.^{3, 4} This includes the continued lack of awareness within the healthcare sector and the wider community that palliative care services can be complementary to active treatment and not reserved for end-of-life care.⁵ Continued effort must be made to reduce these barriers to care and integrate palliative care services as early as possible, from when curative or life-prolonging (disease-modifying) treatment is occurring through to when death may be imminent. This is addressed within the Standard where the benefits of palliative care are highlighted for patients first diagnosed with a life-limiting condition receiving active interventions through to patients with progressive, advanced disease with little to no prospect of cure.

A conceptual framework to underpin access to palliative care services has also been developed to help guide health professionals.⁶ This, along with key messaging to facilitate engagement with and promotion of palliative care services, has been advocated as an approach to improve the care of individuals with serious illness. There remain significant challenges to adopting these concepts into routine clinical practice. Unfortunately, palliative care, for many healthcare professionals and patients, is perceived to be only for end-of-life care, and it is paramount that we continue to change this misconception and integrate palliative care services as early as possible to provide the benefits we know exist for patients and their families.

SHPA and the authors are to be congratulated for formulating a position on end-of-life care and voluntary assisted dying (VAD) for the profession. This would have been incredibly challenging whilst considering the views of many palliative care pharmacists with differing and valid perspectives. The passion, professional leadership, and commitment of all the authors to this task is to be commended. This work has resulted in a position statement that is true to the underlying principles that everyone shares a fundamental right to safe and high-quality health care. This is reflected in the statement that all patients expressing a desire to access VAD should be supported and referred to appropriate services in their jurisdiction and are not precluded from accessing palliative care services. I am encouraged that pharmacists practicing palliative care will, as this Standard emphasises, offer the same level and quality of palliative care services to any patient, regardless of a decision to access VAD.

There continue to be many challenges to improving access to palliative care services, including changes in practice, policy, and education across all sectors.⁷ This Standard provides a clear consensus for the pharmacy profession to influence the provision of care that is person- and carer-centred. I look forward to my colleagues within the profession embracing the values and priorities that have been so carefully crafted within the Practice Standard into their practice.

Michael J. Dooley is Editor-in-Chief of the Journal of Pharmacy Practice and Research. Michael J. Dooley is the Director of the Victorian Voluntary Assisted Dying Pharmacy Service.

Michael J. Dooley: conceptualisation, writing – original draft, writing – reviewing and editing.

Ethics approval was not required for this editorial as it did not contain any human data or participants.

Not commissioned, not externally peer reviewed.

This editorial received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.