Managing medicines at the end of life: a position paper for health policy and practice

Latif, Asam; Faull, Christina; Waring, Justin; Wilson, Eleanor; Anderson, Claire; Avery, Anthony; Pollock, Kristian

Abstract

Purpose The impact of population aging is significant, multifaceted and characterised by frailty and multi-morbidity. The COVID-19 pandemic has accelerated care pathways and policies promoting self-management and home-based care. One under-researched area is how patients and family caregivers manage the complexity of end-of-life therapeutic medicine regimens. In this position paper we bring attention to the significant strain that patients and family caregivers experience when navigating and negotiating this aspect of palliative and end-of-life care. Methodological approach Focusing on self-care and organisation of medicines in the United Kingdom (UK) context, the paper examines, builds on and extends the debate by considering the underlying policy assumptions and unintended consequences for individual patients and family care givers as they assume greater palliative and end-of-life roles and responsibilities. Key messages Policy makers and healthcare professionals often lack awareness of the significant burden and emotional work associated with managing and administering often potent high-risk medicines (i.e. opioids) in the domiciliary setting. The recent 'revolution' in professional roles associated with the COVID-19 pandemic, including remote consultations and expanding community-based care, means there are opportunities for commissioners to consider offering greater support. The prospect of enhancing the community pharmacist's medicine optimisation role to further support the wider multidisciplinary team is considered. Originality/value The paper takes a person-focused perspective and adopts a holistic view of medicine management. We argue for urgent review, reform and investment to enable and support terminally ill patients and family caregivers to more effectively manage medicines in the domiciliary setting. There are clear implications for pharmacists and these are discussed in the context of public awareness, inter-professional collaboration, organisational drivers, funding and regulation, and remote care delivery.

Citation

Latif, A., Faull, C., Waring, J., Wilson, E., Anderson, C., Avery, A., & Pollock, K. (2021). Managing medicines at the end of life: a position paper for health policy and practice. Journal of Health Organization and Management, 35(9), 368-377. https://doi.org/10.1108/JHOM-11-2020-0440

• Journal Article Type: Article
• Acceptance Date: Jul 30, 2021
• Online Publication Date: Nov 18, 2021
• Publication Date: Dec 17, 2021
• Deposit Date: Sep 1, 2021
• Publicly Available Date: Nov 18, 2021
• Journal: Journal of Health Organization and Management
• Print ISSN: 1477-7266
• Publisher: Emerald
• Peer Reviewed: Peer Reviewed
• Volume: 35
• Issue: 9
• Pages: 368-377
• DOI: https://doi.org/10.1108/JHOM-11-2020-0440
• Keywords: Palliative Care; Community Pharmacy; End-of-life; Article type: Viewpoint 2
• Public URL: https://nottingham-repository.worktribe.com/output/6138916
• Publisher URL: https://www.emerald.com/insight/content/doi/10.1108/JHOM-11-2020-0440/full/html