The primary focus of palliative medication treatment during hospice care is to enhance comfort and improve the quality of the patient’s life. Medications are selected based upon ability to relieve symptoms, not their effect upon the underlying disease process. The patient, physician, primary caregiver and other interdisciplinary healthcare professionals all participate in the selection of medication therapies and should all agree that treatment modalities will be non-invasive, symptom-driven, and not intended to modify the disease. Troublesome symptoms encountered during the final stages of a terminal illness, which may be targeted effectively with medication, include severe pain, persistent nausea and vomiting, anxiety, and delirium. Relief of these and other symptoms may allow for the patient and their family to avoid severe discomfort and experience death with dignity. Prolonged life, though not the goal of medication therapy, may occur due to effective symptom relief and emotional support.
Experienced Pharmacists and specialized pharmacy benefit management organizations (PBMs) are an integral part of the team that ensures successful palliative medication utilization for hospice patients. Some of the critical support services that may be provided by a premier hospice PBM include:
- Around-the-clock access to clinical pharmacists with extensive palliative care experience in order to assist nurses and physicians with critical medication issues, such as effective pain management with powerful opioid medications
- Serving as an effective resource for developing policies and systems to achieve effective and reliable medication utilization throughout the hospice organization
- Access to a network of pharmacies that are capable of providing the necessary medications for successful palliative care around-the-clock
- Establishment of processes to anticipate and respond to the patient’s “emergency” needs for medication in the home
- Providing oversight, analysis, and guidance pertaining to medication utilization for the hospice organization
- Serving as a medication information resource to the hospice by providing the most up-to-date information on medication therapy through staff education and ongoing routine support
When allied with a leading PBM and supported by the clinical expertise of pharmacists trained in geriatric medicine and palliative symptom management, hospices can enhance medication therapy management, thereby improving the overall quality of care provided to patients. Patients and their families deserve the very best care and compassion at end of life, and an interdisciplinary effort is required to achieve what the founder of the modern hospice movement, Cicely Saunders, called “a good death.” Everyone should have the right to "die well", without pain and with dignity.
By: Jim Joyner, PharmD, CGP