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Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Community pharmacy service provision to adults with palliative care needs in their last year of life: a scoping review

Sheng-Ting Chiu https://orcid.org/0009-0000-4822-8299 1 * , Trudi Aspden 1 , Shane Scahill 1
+ Author Affiliations
- Author Affiliations

1 School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.

* Correspondence to: sheng-ting.chiu@auckland.ac.nz

Handling Editor: Tim Stokes

Journal of Primary Health Care 16(4) 398-406 https://doi.org/10.1071/HC24089
Submitted: 28 June 2024  Accepted: 2 September 2024  Published: 13 September 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

The provision of palliative care is central to primary health care delivery. In this setting, community pharmacies often act in a medication supply role, yet their broader involvement in supporting people in the last year of life is less well understood.

Aim

This study aimed to review the literature on community pharmacies supporting adults with palliative care needs in their last year of life, emphasising challenges to optimising their role and improving equity and service accessibility.

Methods

A five-stage scoping review using a comprehensive literature search was conducted using MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and grey literature up to 30 April 2024. Eligible articles were charted, descriptively analysed, and mapped to a bicultural and holistic health care model, Te Whare Tapa Whā Older Person’s Palliative Care model.

Results

Twenty-five studies from seven countries were reviewed, revealing that community pharmacies provide a range of services to support people with palliative care needs. The main role of community pharmacies resides in Tinana, the physical health domain of Te Whare Tapa Whā Older Person’s Palliative Care model. Challenges experienced by pharmacy staff include communication with palliative care service providers and users, integrating their role into palliative care provision, addressing their educational needs, and managing palliative medication stock.

Discussion

The role of community pharmacy in providing palliative care is not widely understood. If the challenges identified in these studies can be addressed, there is potential for community pharmacies to offer a more proactive palliative care approach to their communities.

Keywords: community pharmacy, hospice care, models of care, palliative care, palliative medicine, pharmacy services, primary health care, terminal care.

References

Ministry of Health NZ. Palliative care action plan. 2017. Available at www.health.govt.nz/system/files/documents/publications/palliative-care-action-plan_0.pdf [cited 8 August 2023].

Ministry of Health N. Health and Disability System Review Executive overview | He tirohanga whānui. 2020. Available at www.health.govt.nz/publications/health-and-disability-system-review-final-report

Gott M, Seymour J, Ingleton C, et al. That’s part of everybody’s job’: the perspectives of health care staff in England and New Zealand on the meaning and remit of palliative care. Palliat Med 2012; 26(3): 232-41.
| Crossref | Google Scholar | PubMed |

Robinson J, Frey R, Raphael D, et al. Difficulties in navigating the intersection of generalist and specialist palliative care services: a cross-sectional study of bereaved family’s experiences of care at home in New Zealand. Health Soc Care Community 2022; 30(1): 133-41.
| Crossref | Google Scholar | PubMed |

Moeke-Maxwell T, Mason K, Toohey F, et al. Pou Aroha: An Indigenous Perspective of Māori Palliative Care, Aotearoa New Zealand. In: MacLeod RD, Block L, editors. Textbook of Palliative Care. Springer International Publishing; 2019. pp. 1247–63.

Iupati S, Macleod R, Stanley J, et al. Community specialist palliative care services in New Zealand: a survey of Aotearoa hospices. N Z Med J 2022; 135(1566): 36-48.
| Crossref | Google Scholar | PubMed |

Stajduhar K, Gott M. Closing the health equity gap in palliative care: the time for action is now. Palliat Med 2023; 37: 424-5.
| Crossref | Google Scholar | PubMed |

Gott M, Wiles J, Mason K, et al. Creating ‘safe spaces’: a qualitative study to explore enablers and barriers to culturally safe end-of-life care. Palliat Med 2023; 37(4): 520-9.
| Crossref | Google Scholar | PubMed |

Moeke-Maxwell T, Collier A, Wiles J, et al. Bereaved families’ perspectives of end-of-life care. Towards a bicultural whare tapa whā older person’s palliative care model. J Cross Cult Gerontol 2020; 35(2): 177-93.
| Crossref | Google Scholar | PubMed |

10  Tordoff J, Chang SY, Norris PT. Community pharmacists’ perceptions of services that benefit older people in New Zealand. Int J Clin Pharm 2012; 34(2): 342-50.
| Crossref | Google Scholar | PubMed |

11  Ilardo ML, Speciale A. The community pharmacist: perceived barriers and patient-centered care communication. Int J Environ Res Public Health 2020; 17(2): 536.
| Crossref | Google Scholar | PubMed |

12  Kidd J, Reid S, Collins N, et al. Kia Mau te Kahu Whakamauru: Health Literacy in Palliative Care. 2014. Available at www.fmhs.auckland.ac.nz/assets/fmhs/faculty/ABOUT/newsandevents/docs/Health%20literacy%20in%20palliative%20care%20report%20final.pdf

13  Love T, Moore D, Li W, et al. Independent Review of Community Pharmacy Services (Stage One). December 2020. Available at www.thinkSapere.com

14  Chistiansen L. A Holistic Model of Oranga Te Whare Tapa Whā in Tess Moeke-Maxwell’s The Kōwhai Study, Māreikura Tū Kōwhai: Younger Māori Women’s Wellness programme after Breast Cancer. Auckland: The University of Auckland; 2020.

15  Peters MD, Godfrey CM, Khalil H, et al. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015; 13(3): 141-6.
| Crossref | Google Scholar | PubMed |

16  Khalil H, McInerney P, Pollock D, et al. Practical guide to undertaking scoping reviews for pharmacy clinicians, researchers and policymakers. J Clin Pharm Ther 2022; 47: 129-34.
| Crossref | Google Scholar | PubMed |

17  Munn Z, Peters MDJ, Stern C, et al. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol 2018; 18(1): 143.
| Crossref | Google Scholar | PubMed |

18  Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth 2020; 18(10): 2119-26.
| Crossref | Google Scholar | PubMed |

19  Tricco A, Peters M, Pollock D, et al. JBI Scoping Review Network. Joanna Briggs Institute; 2019. Available at https://jbi.global/scoping-review-network [cited 11 October 2023].

20  Daudt HML, Van Mossel C, Scott SJ. Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Med Res Methodol 2013; 13: 48.
| Crossref | Google Scholar | PubMed |

21  Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. 2010. Available at http://www.cihr-irsc.ca

22  Aromataris E, Riitano D. Constructing a search strategy and searching for evidence. Am J Nurs 2014; 114(5): 49-56.
| Crossref | Google Scholar | PubMed |

23  Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005; 8(1): 19-32.
| Crossref | Google Scholar |

24  Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018; 169: 467-73.
| Crossref | Google Scholar | PubMed |

25  Herndon CM, Nee D, Atayee RS, et al. ASHP guidelines on the pharmacist’s role in palliative and hospice care. Am J Health Syst Pharm 2016; 73(17): 1351-67.
| Crossref | Google Scholar | PubMed |

26  Swetenham K, Rowett D, Stephenson D. Clinical networks influencing policy and practice: the establishment of advanced practice pharmacist roles for specialist palliative care services in South Australia. Aust Health Rev 2014; 38(2): 238-41.
| Crossref | Google Scholar | PubMed |

27  End of Life Directions for Aged Care. ELDAC Care Model. End of Life Directions for Aged Care; 2021. Available at https://www.eldac.com.au/ [cited 1 September 2023].

28  Needham DS, Wong ICK, Campion PD. Evaluation of the effectiveness of UK community pharmacists’ interventions in community palliative care. Palliat Med 2002; 16(3): 219-25.
| Crossref | Google Scholar | PubMed |

29  Lucey M, McQuillan R, MacCallion A, et al. Access to medications in the community by patients in a palliative setting. A systems analysis. Palliat Med 2008; 22(2): 185-9.
| Crossref | Google Scholar | PubMed |

30  Atayee RS, Best BM, Daniels CE. Development of an ambulatory palliative care pharmacist practice. J Palliat Med 2008; 11(8): 1077-82.
| Crossref | Google Scholar | PubMed |

31  Ise Y, Morita T, Maehori N, et al. Role of the community pharmacy in palliative care: a nationwide survey in Japan. J Palliat Med 2010; 13(6): 733-7.
| Crossref | Google Scholar | PubMed |

32  Wilson S, Wahler R, Brown J, et al. Impact of pharmacist intervention on clinical outcomes in the palliative care setting. Am J Hosp Palliat Med 2011; 28(5): 316-20.
| Crossref | Google Scholar | PubMed |

33  Hussainy SY, Box M, Scholes S. Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience. BMC Palliat Care 2011; 10: 16.
| Crossref | Google Scholar | PubMed |

34  O’Connor M, Fisher C, French L, et al. Exploring the community pharmacist’s role in palliative care: focusing on the person not just the prescription. Patient Educ Couns 2011; 83(3): 458-64.
| Crossref | Google Scholar | PubMed |

35  Akram G, Bennie M, McKellar S, et al. Effective delivery of pharmaceutical palliative care: challenges in the community pharmacy setting. J Palliat Med 2012; 15(3): 317-21.
| Crossref | Google Scholar | PubMed |

36  O’Connor M, Hewitt LY, Tuffin PHR. Community pharmacists’ attitudes toward palliative care: an Australian nationwide survey. J Palliat Med 2013; 16(12): 1575-81.
| Crossref | Google Scholar | PubMed |

37  Savage I, Blenkinsopp A, Closs SJ, et al. Like doing a jigsaw with half the parts missing’: community pharmacists and the management of cancer pain in the community. Int J Pharm Pract 2013; 21(3): 151-60.
| Crossref | Google Scholar | PubMed |

38  Tait PA, Gray J, Hakendorf P, et al. Community pharmacists: a forgotten resource for palliative care. BMJ Support Palliat Care 2013; 3(4): 436-43.
| Crossref | Google Scholar | PubMed |

39  Maidment ID, Aston L, Moutela T, et al. A qualitative study exploring medication management in people with dementia living in the community and the potential role of the community pharmacist. Health Expect 2017; 20(5): 929-42.
| Crossref | Google Scholar | PubMed |

40  Akram G, Corcoran ED, MacRobbie A, et al. Developing a model for pharmaceutical palliative care in rural areas—experience from Scotland. Pharmacy 2017; 5(1): 6.
| Crossref | Google Scholar | PubMed |

41  Tait PA, Cheung WH, Wiese M, et al. Improving community access to terminal phase medicines in Australia: identification of the key considerations for the implementation of a ‘core medicines list’. Aust J Prim Health 2017; 23(4): 373-8.
| Crossref | Google Scholar | PubMed |

42  Cortis LJ. A qualitative study to describe patient-specific factors that relate to clinical need for and potential to benefit from a medication management service in palliative care. J Pharm Pract Res 2017; 47(1): 34-40.
| Crossref | Google Scholar |

43  Edwards Z, Blenkinsopp A, Ziegler L, et al. How do patients with cancer pain view community pharmacy services? An interview study. Health Soc Care Community 2018; 26(4): 507-18.
| Crossref | Google Scholar | PubMed |

44  Kuruvilla L, Weeks G, Eastman P, et al. 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 2018; 32(8): 1369-77.
| Crossref | Google Scholar | PubMed |

45  Suzuki S, Uchida M, Suga Y, et al. A nationwide survey of community pharmacist contributions to polypharmacy in opioid-using and non-using cancer patients in Japan. Biol Pharm Bull 2019; 42(7): 1164-71.
| Crossref | Google Scholar | PubMed |

46  Edwards Z, Bennett MI, Blenkinsopp A. A community pharmacist medicines optimisation service for patients with advanced cancer pain: a proof of concept study. Int J Clin Pharm 2019; 41(3): 700-10.
| Crossref | Google Scholar | PubMed |

47  Miller EJ, Morgan JD, Blenkinsopp A. How timely is access to palliative care medicines in the community? A mixed methods study in a UK city. BMJ Open 2019; 9(11): e029016.
| Crossref | Google Scholar | PubMed |

48  Latter S, Campling N, Birtwistle J, et al. Patient and carer access to medicines at end of life: the ActMed mixed-methods study. Health Soc Care Deliv Res 2022; 10(20): 1-208.
| Crossref | Google Scholar | PubMed |

49  Inderlall R, Naidoo P. Role of pharmacists in the provision of palliative care services and support in South Africa. Int J Pharm Pract 2021; 29(2): 157-63.
| Crossref | Google Scholar | PubMed |

50  Tait P, Chakraborty A, Jones K, et al. What is the community pharmacists’ role in supporting older Australians with palliative care needs? Healthcare 2021; 9(5): 489.
| Crossref | Google Scholar | PubMed |

51  Tait P, Sheehy K, Sindhusake D, et al. Factors affecting access to subcutaneous medicines for people dying in the community. Prog Palliat Care 2020; 28(5): 326-33.
| Crossref | Google Scholar |

52  Homann K, Bertsche T, Schiek S. Pharmacy technicians’ perception about symptoms and concerns of older patients visiting pharmacies: a cross-sectional study. J Multidiscip Healthc 2021; 14: 103-14.
| Crossref | Google Scholar | PubMed |

53  Latter S. Access to palliative and end-of-life care medicines: supporting community pharmacy’s role. Int J Pharm Pract 2022; 30(4): 295-6.
| Crossref | Google Scholar | PubMed |

54  Latif A, Faull C, Ali A, et al. Caring for palliative care patients at home: medicines management principles and considerations. Pharm J 2020;
| Crossref | Google Scholar |

55  Pollock K, Wilson E, Caswell G, et al. Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study. Health Serv Delivery Res 2021; 9(14): 1-162.
| Crossref | Google Scholar | PubMed |

56  Herledan C, Cerfon MA, Baudouin A, et al. Impact of pharmaceutical care interventions on multidisciplinary care of older patients with cancer: a systematic review. J Geriatr Oncol 2023; 14(4): 101450.
| Crossref | Google Scholar | PubMed |

57  Valença-Feitosa F, Carvalho GAC, Alcantara TS, et al. Identifying health outcomes of pharmaceutical clinical services in patients with cancer: a systematic review. Res Social Adm Pharm 2023; 19(4): 591-8.
| Crossref | Google Scholar | PubMed |

58  Franco J, de Souza RN, Lima TdM, et al. Role of clinical pharmacist in the palliative care of adults and elderly patients with cancer: a scoping review. J Oncol Pharm Pract 2022; 28(3): 664-85.
| Crossref | Google Scholar | PubMed |

59  Quinn C. Medication use in palliative and end of life care. Doctor of Philosophy Thesis. Queen’s University, Belfast; 2020.

60  Dunne K, Sullivan K, Kernohan G. Palliative care for patients with cancer: District nurses’ experiences. J Adv Nurs 2005; 50(4): 372-80.
| Crossref | Google Scholar | PubMed |

61  van Gaans D, Erny-Albrecht K, Tieman J. Palliative care within the primary health care setting in Australia: a scoping review. Public Health Rev 2022; 43: 1604856.
| Crossref | Google Scholar | PubMed |

62  McDonald J, Morris C, Pledger M, et al. A national survey of pharmacists and interns in Aotearoa New Zealand: provision and views of extended services in community pharmacies. BMC Health Serv Res 2021; 21(1): 1147.
| Crossref | Google Scholar | PubMed |

63  Scahill SL, Atif M, Babar ZU. Defining pharmacy and its practice: a conceptual model for an international audience. Integr Pharm Res Pract 2017; 6: 121-9.
| Crossref | Google Scholar | PubMed |

64  Smith AJ, Scahill SL, Harrison J, et al. Service provision in the wake of a new funding model for community pharmacy. BMC Health Serv Res 2018; 18(1): 307.
| Crossref | Google Scholar | PubMed |

65  Taylor S, Cairns A, Glass B. Role theory: a framework to explore health professional perceptions of expanding rural community pharmacists’ role. Pharmacy 2020; 8(3): 161.
| Crossref | Google Scholar | PubMed |

66  Torensma M, Onwuteaka-Philipsen BD, de Voogd X, et al. The role of research in improving responsiveness of palliative care to migrants and other underserved populations in the Netherlands: a qualitative interview study. BMC Palliat Care 2021; 20(1): 5.
| Crossref | Google Scholar | PubMed |

67  Elk R, Felder TM, Cayir E, et al. Social inequalities in palliative care for cancer patients in the United States: a structured review. Semin Oncol Nurs 2018; 34(3): 303-15.
| Crossref | Google Scholar | PubMed |

68  Taylor SM, Cairns A, Glass BD. Expanded practice for rural community pharmacy: what are we waiting for? Int J Pharm Pract 2022; 30(1): 86-8.
| Crossref | Google Scholar | PubMed |

69  Ali A. A qualitative investigation of lay and professional perspectives of community pharmacy extended palliative care services Doctor of Philosophy Thesis. The University of Nottingham, Nottingham, UK; 2021.

70  Wilson A, Hope D, Hattingh L. The evolving public health role of pharmacists in pandemics: a scoping review. Aust Pharm Stud Js 2023; 2(1): 18-27.
| Google Scholar |