Since 2004 I have had the privilege of being the clinical pharmacist at Daw House, a 15-bed hospice based at Repat Hospital, which is in the original homestead built prior to the hospital’s 1942 inception. The first patient came to Daw House in 1988 and the last left in 2017, transferred to the new Laurel Hospice at Flinders Medical Centre.
During the time that I have been with Southern Adelaide Palliative Service, the nature of palliative care has changed enormously. It is no longer primarily about comfort care at the end of life, as the palliative care team becomes involved with the patient much earlier in their disease course and walks beside them during its trajectory, even while clinicians from other specialities are still involved with their care. More than ever, the pharmacist is an integral part of the team within a palliative care service, because patients actually do go home, having had their symptoms (hopefully) improved and with multiple changes to their medications – who better to explain these to them than the pharmacist?
It is crucial for hospital pharmacists to liaise with community healthcare providers because we in Australia are spoilt for choice these days in terms of the medications which can be prescribed, particularly for pain management and also for end of life care. However, not all general practitioners are familiar with these medications and not all community pharmacies stock them routinely, so communication between the care providers in hospital and in the community becomes an integral part of the hospital pharmacist’s role.
While palliative medicine can be quite specialised, retaining an overview of general medicine is relevant for a palliative care pharmacist, because many patients are still on active treatment for their comorbidities and it’s helpful to weigh up the pros and cons of continuing versus ceasing these in consultation with the doctors, and ideally with the patients as well.
I have enjoyed the teaching opportunities which working in palliative care has brought me, and I don’t forget that a clinical pharmacist can likewise learn from the nurses and doctors. Often there is more than one right way of doing things – I value the fact that palliative care can still be somewhat empirical in these days of evidence-based medicine (although there is of course a place for research, who am I to say that a particular complementary therapy has little scientific evidence behind it, when the individual in front of me finds it beneficial?) and appreciate the doctors’ willingness to think ‘outside the box’. I find myself in awe of the nurses and their manner/mannerisms; a little black humour goes a long way!
We can also learn from the patients and their families many of whom accept the position they are in with stoicism and grace. There will always be those with complicated issues, not only medical but psychosocial and even spanning across generations, which is why the multidisciplinary approach of the entire palliative care team is so important; social worker, psychiatrist, art therapist, complementary care, pet therapy dogs and their handlers - just to name a few.
Southern Adelaide Palliative Services is more than just a team; I found myself to be part of a community. For staff and patients alike, Daw House came to feel like home. Hopefully Laurel Hospice will do likewise.
Jenny Casanova, Senior Clinical Pharmacist, Southern Adelaide Local Health Network