October is American Pharmacists Month and we are excited to present to you a series of videos throughout the month by our very own, Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care! Hospice of Southern Illinois is very proud to have the honor of hosting the only PGY-2 (post-graduate, year 2) in Pain and Palliative Care Pharmacy Residency Program fully funded a hospice, in the United States. So, we present to you our next video in the series on Goals of Care.
Goals of Care
Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care
Hospice of Southern Illinois
The goals of care in hospice are much different than in other areas of the healthcare field. In hospice, the goal is to help comfort both the patient and the patient’s family. This is done through medication use and spiritual guidance of patient and family, if requested. Treatment transitions from disease oriented care into symptomatic management.
Many times the medications used to treat a patient’s disease prior to admittance into hospice are no longer required after acceptance. There are an innumerable amount of medications which this applies to, but that is why often we tell the family medication A and B are no longer required, while we may add medication C for control of different patient symptoms. In the end, discontinuation of medications is a families right and they have the final say. Clinical recommendations can be made, but that does not mean the families do not have the right to counter the recommendation.
Often, the problem comes up when a medication is recommended to be discontinued but the family wants to continue it. What are the real problems with this scenario? Well it fully depends on the patient, the medication, and any other patient specific variable. Sometimes the recommendation comes from the fact that the medication may have no clinical trials demonstrating palliative benefits to patients. So just because it has no palliative benefits that means it needs to be discontinued? Not necessarily, however, we must assess the whole situation.
While admitted on hospice many times patients slowly lose their ability to swallow, not only food and liquids, but also medications. Pill burden at this time becomes a problem not only for patients, but also for the families. Trying to get their loved ones to swallow pills or liquid can be cumbersome. This results in a problem from a hospice side of trying to improve the quality of the patients remaining life. Taking one extra pill may not seem like much, but what about if its 4 extra pills needing to be given at three different time intervals each day?
Like anything, each patient is unique and treated on a case-by-case basis. Yes exceptions to the “normal” rules can be made, however the end goal of hospice is to increase the quality of life of both the patients and families.