Abstract
People managing cancer and comorbid conditions use medicines throughout the disease trajectory. Little is known about the support they receive for medication management. This study asked, what are the shared experiences of pharmacists caring for people with cancer? This paper aims to describe the types of drug related problems (DRPs) encountered, and how they are resolved in practice.
Semi-structured in-depth interviews were conducted with a purposive sample of Registered Pharmacists working in primary and/or specialist cancer care. Interviews were transcribed in full and thematically analysed. Nineteen pharmacists ranging in practice profiles were interviewed. Thematic saturation was achieved.
Three categories of DRPs were described: potential, multifaceted and actual problems. Potential DRPs were commonly identified by specialist pharmacists through systematic clinical pharmacy processes and by the cancer multidisciplinary team. Potential DRPs were considered easy to resolve if managed within the hospital. Multifactorial DRPs were less commonly described. Identification did not depend on setting of care but on the pharmacist conducting an in-depth consultation utilising a patient-centric approach. Multifactorial DRPs were complex, involved medicines administered in patients’ homes and crossed boundaries of care. They were universally considered challenging to resolve. Actual DRPs were frequently encountered by community pharmacists and specialist cancer pharmacists. Actual DRPs related to adverse drug effects or drug interactions not proactively managed. Community pharmacists resolved these directly with patients through self-management. Actual DRPs encountered in specialist care were managed acutely within the hospital environment.
Proactive management of potential DRPs within the acute treatment phase is the primary focus of pharmacy services in cancer. Despite their availability and skillset, primary care pharmacists have limited experiences in identifying and managing DRPs in cancer. This service gap manifests as actual DRPs requiring reactive management. This has been interpreted as professional inattentional blindness; inability to detect unexpected objects to which we aren’t paying attention.
Semi-structured in-depth interviews were conducted with a purposive sample of Registered Pharmacists working in primary and/or specialist cancer care. Interviews were transcribed in full and thematically analysed. Nineteen pharmacists ranging in practice profiles were interviewed. Thematic saturation was achieved.
Three categories of DRPs were described: potential, multifaceted and actual problems. Potential DRPs were commonly identified by specialist pharmacists through systematic clinical pharmacy processes and by the cancer multidisciplinary team. Potential DRPs were considered easy to resolve if managed within the hospital. Multifactorial DRPs were less commonly described. Identification did not depend on setting of care but on the pharmacist conducting an in-depth consultation utilising a patient-centric approach. Multifactorial DRPs were complex, involved medicines administered in patients’ homes and crossed boundaries of care. They were universally considered challenging to resolve. Actual DRPs were frequently encountered by community pharmacists and specialist cancer pharmacists. Actual DRPs related to adverse drug effects or drug interactions not proactively managed. Community pharmacists resolved these directly with patients through self-management. Actual DRPs encountered in specialist care were managed acutely within the hospital environment.
Proactive management of potential DRPs within the acute treatment phase is the primary focus of pharmacy services in cancer. Despite their availability and skillset, primary care pharmacists have limited experiences in identifying and managing DRPs in cancer. This service gap manifests as actual DRPs requiring reactive management. This has been interpreted as professional inattentional blindness; inability to detect unexpected objects to which we aren’t paying attention.
| Original language | English |
|---|---|
| Pages (from-to) | 136 |
| Number of pages | 1 |
| Journal | Asia-Pacific Journal of Clinical Oncology |
| Volume | 15 |
| Issue number | S9 |
| Early online date | 31 Oct 2019 |
| DOIs | |
| Publication status | Published - Nov 2019 |
| Event | Clinical Oncology Society of Australia 46th Annual Scientific Meeting: Putting Precision and Personalisation into Practice - Adelaide Convention Centre, Adelaide, Australia Duration: 12 Nov 2019 → 14 Nov 2019 https://www.cosa.org.au/events/past-annual-scientific-meetings/ (List of past COSA ASMs, including the 46th.) |
Keywords
- Cancer care
- Pharmacists
- Medication
- Drug related problems
