Pharmaceutical Care of the Dying

Author: Paul Tait

Tait, Paul, 2022 Pharmaceutical Care of the Dying, Flinders University, College of Nursing and Health Sciences

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Australians may well live the last year of their life at home, challenging governments and organisations to administer safe and affordable palliative care beyond the acute sector. While multiple factors contribute to safe and cost-effective palliative services in the home, good medication management is critical in managing symptoms.

However, people with palliative needs are vulnerable to medication-related problems, resulting in hospital admission, noncompliance, and out-of-pocket costs - impacting how those living in the community manage symptoms. As medication experts, pharmacists are uniquely placed within the multidisciplinary team to review and evaluate these risks and facilitate better strategies. However, the complex environment in which people and their caregivers receive palliative care jeopardises the pharmacist's routine involvement.

This thesis aimed to make an original and significant contribution to knowledge about pharmacists, caregivers, and medications regarding the care of the dying in the home environment. Rather than use a standard approach, this thesis considered six previously published works to form a PhD by Prior Publication (PhD PP). A PhD PP is a unique approach that takes previously published studies and examines these collectively, within the context of hindsight. Significantly, I wrote these six publications while conducting this research primarily as a clinician-researcher, which was declared and addressed throughout the thesis. In addition, the thesis used a conceptual model describing the complexity of managing people with multiple comorbidities to facilitate this collective examination.

Understanding the challenges pharmacists and caregivers face in managing the use of medications in people with palliative needs in the home environment is fundamental to developing and appropriately using resources. The first two publications investigated the various medications stocked in South Australian community pharmacies and a strategy for improving the reliability of medications stocked. A further two publications considered the impact of this strategy from the perspective of the community pharmacist and how this impacts their collaboration with a broader multidisciplinary team. A fifth publication identifies the evidence underpinning the community-based pharmacist's role in collaborating with the multidisciplinary team to support older people with palliative needs. The final publication studied the factors associated with caregivers indicating which factors were associated with more significant support in understanding the medications when caring for someone with palliative needs. In re-examining these publications, this thesis establishes new insights that provide a window into the critical issues in how people with palliative needs manage medications in the home environment, with learnings for other aspects of care delivery.

Three insights inform the findings, including challenges with funding models, clinical communication, and standardised approaches to care. In detailing these, it became evident that clinicians used some helpful strategies poorly when managing the care of people with palliative needs in the community. Furthermore, this thesis identifies gaps in how governments and organisations fund and allocate resources. Finally, this thesis identifies significant omissions in the evidence base regarding good pharmaceutical care for the dying.

As organisations and governments grapple with the challenge of delivering safe and affordable care for a rapidly growing number of people with palliative needs, this analysis will be critical in future planning.

Keywords: pharmaceutical, care, dying, death, life-limiting, medications, medicines, pharmacists, health, palliative, community, clinical, clinician, prior, publication

Subject: Pharmacy thesis

Thesis type: Doctor of Philosophy
Completed: 2022
School: College of Nursing and Health Sciences
Supervisor: Professor Jennifer Tieman