An overview of pharmacist roles in palliative care: A worldwide comparison

Background. In order to fulfil the complex needs of terminally ill patients, palliative care demands an inter-professional collaborative network, including doctors, nurses, dieticians and social workers. Pharmacists in particular are essential members of this team, given the level of reliance on medications in this setting. The purpose of this review is to identify roles and services performed by palliative care pharmacists in dedicated palliative care settings worldwide and to map these findings against the Advanced Pharmacy Practice Framework. Material and methods. Quasi-systematic review. Search strategy: Google Scholar, Medline/PubMed, Scopus and Embase were searched utilizing selected MeSH terms. Results. A total of 24 sources of information were included in the review. This literature was collected from a range of countries, predominantly from the USA, UK and Australia with singular reports from Mexico, Japan, Qatar, Canada, Poland and Sweden. The literature identifies that pharmacist roles in palliative care are varied and quite extensive. Roles that were specifically tailored to the palliative setting included: Aggressive symptom management (in particular pain control), deprescribing, advising on the use of complementary and alternative therapies, extemporaneous compounding of non-standard dosage forms and maintaining a timely supply of medications. Pharmacists in the UK, USA, Canada and Australia were found to perform an advanced level of practice (as their reported roles fulfilled the criteria of the majority of the domains in the APPF). However, pharmacists in other countries, in particular Mexico and Poland, did not present such an extensive scope of practice. Conclusion. The literature identifies that there are differences in the types of palliative pharmacist practice between countries, which may have varying levels of impact upon patient outcomes. As pharmacists can make significant contributions to palliative care, it is important to encourage the benchmarking of practice across different clinical settings and countries to promote a consistent and equitable practice.