Symptoms
PSA’s ASPIRE Palliative Care Foundation Training Program gives pharmacists the skills to deliver this vital care – to patients and families alike.
Australia’s population is living to a greater age, which in turn has led to increased need for end-of-life care. It’s estimated that demand for palliative care in Australia will rise by 50% between now and 2035, and double by 2050.
Until now, most pharmacists have had to navigate complex medication regimes and challenging family conversations – with little to no formal training during university studies.
To help bridge this gap, PSA launched the ASPIRE Palliative Care Foundation Training Program last year. The course, delivered online across eight modules, aims to equip pharmacists with essential, proactive skills – not only for patients, but for the family and carers who also require significant support.
‘The ASPIRE training reminded me that palliative care is not just the last few days of life, it’s actually the weeks, months and sometimes even years after a person has a diagnosis that means that their life is going to be shortened,’ said Amy Gibson MPS, a consultant clinical pharmacist and educator who works as an on-site pharmacist in an Aspect Health aged care facility outside Brisbane.
‘Palliative care is about making plans to keep that patient as comfortable and in the best health possible for the time they’ve got left – often it’s heart failure and chronic lung disease patients.’
A holistic approach
Before completing the ASPIRE training program, Ms Gibson said she ‘didn’t have a lot of skills around palliative care’.
‘I knew about what we refer to as the “Core Four” medicines. I knew about anticipatory prescribing and making sure you’ve got something on hand for pain management, agitation and so on,’ she said.
‘But I hadn’t really thought so much about those social aspects of having conversations with people to find out what actual issues they were having, and how as a pharmacist you could support them.’
While not designed to prepare pharmacists to specialise in palliative care, the ASPIRE training course explores a broad range of topics around end-of-life issues, from symptom management and interdisciplinary palliative care to the role of the pharmacist across everything from medicine management to bereavement and self-care.
The holistic approach of the training resonated with Ms Gibson. ‘There was a lot of psychosocial education, including around what palliative care patients experience and also what that’s like for their families,’ she said. ‘It reinforced cultural perspectives, particularly for [Aboriginal and Torres Strait Islander] peoples, acknowledging that different cultures deal with death and dying in diverse ways and there’s not a one-size-fits-all approach.’
The ASPIRE training puts the carers’ perspectives in place, said Ruilin Ng MPS, a consultant pharmacist and credentialled diabetes educator based in suburban Adelaide. ‘A lot of the time, people are so focused on the person in care that the person around them is not given as much attention.’
The list of drugs a carer picks up can also be a vital clue for pharmacists to open a conversation. ‘A simple, “How are you”, or “How’s it going”, goes a long way,’ she said.
‘Otherwise family members or carers sometimes fall through the cracks. They may not have the support of a counsellor because obviously the focus is not on them.’
The training also reminds pharmacists of their critical role in being proactive around the most fundamental parts of palliative care, Ms Gibson said.
‘There are cases when people have trouble even physically getting to the pharmacy, saying “We need someone to be with Dad 24/7” for example,’ she said. ‘They don’t have the headspace to say that [coming to the pharmacy] isn’t working for them and might not even realise we can arrange delivery, so there’s a lot of emphasis on the practical measures we can provide.’
Medicine management when it’s most critical
As most people aim to spend their final days at home or in an aged care facility rather than in a hospital, the training helps prepare pharmacists to support them, including the specifics of palliative care medicines management.
‘We can assist [prescribers] in knowing what medicines should be prescribed for comfort measures and what medicines should be ceased because they’re no longer serving a purpose,’ Ms Gibson said.
This also includes making sure the right medicines are available. ‘If your loved one is in pain or quite agitated, you don’t want to be told you’ve got to wait 24 hours because it’s not in stock,’ Ms Gibson said. ‘The training encourages community pharmacies to have these key palliative [care] medicines on hand so patients’ families don’t have to run around the town trying to find supplies.’
In her aged care role, Ms Gibson works closely with registered nurses to maintain an imprest supply. ‘This is emergency stock, including palliative care medicines, that they might need to use before the next delivery from the pharmacy comes,’ she said.
‘If an after-hours GP comes at night and says, “We need to start this patient on a morphine syringe driver”, we’ve got some ready to go – they don’t have to wait until the order arrives at 3.00 pm the next afternoon. I help the nurses monitor that stock. And if we’re running low, I make sure the order goes through to our supply pharmacy in plenty of time.’
The skills Ms Gibson honed through the ASPIRE training program recently helped her treat a resident with advanced dementia who was admitted to hospital but discharged back to the aged care facility with little warning.
‘She was close to the end of [her] life and they’d ceased everything but the palliative [care] medicines, anticipating she wouldn’t [live] more than a couple of days,’ she said.
‘As soon as I saw the message that she was expected back later that day, I checked that we had enough morphine and midazolam to make sure she could be administered those medicines as soon as she got back, because she was unlikely to be sent back to us with [a supply of] those medications.
‘Her doses were escalating quickly and over the next couple of days I made sure we stayed on top of stock levels, putting orders into the pharmacy regularly to make sure we weren’t going to run out overnight.’
The ASPIRE training reinforced the importance of this approach. ‘At the very end of life, the situation can deteriorate quickly, with a change in condition often meaning a change in dose,’ Ms Gibson said.
‘We don’t want people to be uncomfortable and you don’t want to wait a day for the order to arrive. There’s a real need to anticipate what’s going to happen.’
Care after the end
When end of life arrives for the patient, it’s those left behind who need care.
‘The ASPIRE training puts the carer’s perspectives in place, [and] is a very good introduction to the bereavement aspect’ Ms Ng said. ‘[You learn] how to start the conversation, because it’s not an easy topic.’
Pharmacists have an important role in acknowledging carer grief and bereavement after the death of a loved one, and signposting to further support if required.
Keen to learn more about palliative care? Pharmacists, students and interns can enrol free of charge in the Training Plan: ASPIRE Palliative Care Foundation Training Program.
