Talking about palliative care pharmacy – interview with Ebtesam Ahmed

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What does your work as a palliative care pharmacist entail?

My current job entails a variety of clinical, educational and administrative responsibilities. I teach in the Doctor of Pharmacy Program at St. John’s University College of Pharmacy and Health Sciences about pain management, end of life care issues, palliative care and hospice.

In conjunction with my faculty appointment, I am a Clinical Pharmacist Specializing in Pain Management and Palliative Care at MJHS Institute for Innovation in Palliative Care.

I work as a consultant on an interdisciplinary team that provides care for palliative and hospice patients. The other members of the team consist of doctors, nurses, social workers, pastoral counsellors, music therapists or art therapists.

I advise on medication orders, storage, administration and disposal. I provide counselling and education to the palliative care/ hospice team about medication forms and dosages, routes of administrations, costs and availability of various products.

I communicate with patients, families and caregivers about medication to ensure they understand and follow the directions provided with medications. I also participate in clinical research to develop new protocols for the treatment of symptoms in palliative care and hospice settings. 

In your opinion, why is it important for pharmacists to work in palliative care?

It has been reported that 20% of people take at least 8 medications at the time of referral to a specialist palliative care service. Patients and their families might feel very overwhelmed with the amount of medication, lack of education regarding side effects, as well as how to manage these. 

It is important to understand that pharmacists have much to offer in caring for patients with an advanced illness. They are essential in optimizing medication-related outcome; ensuring prescribing is effective and managing side effects.

A patient with chronic pain may have concerns about addiction, more than the actual side effects from the medications. As a result, this patient may not use pain medications properly even when effective management is available.

Thus, pharmacists have an opportunity to positively influence medication-taking behaviour and improve patient outcome by providing education.

What is the biggest challenge facing the field of palliative care pharmacy today?

In my opinion, the largest barrier for a pharmacist in the field of palliative care is one of validation. Having other members of the palliative team, from physicians to social workers, not to mention patients and their loved ones, understand the vital role a pharmacist has in the overall care of advanced illness is incredibly important.

Additionally, I feel that pharmacy school curricula have a huge deficit in teaching our young students-in-training about the definition, importance, and role of a pharmacist in the field of palliative care.

What advice would you give to someone wanting to work as a pharmacist in palliative care?

Pharmacists contemplating working in palliative medicine should understand that treatment is geared not just towards medicine dispensing, but rather encompasses a whole mind-body-soul approach.

It is different from general medicine in the sense that the team may not be able to treat every symptom with medicine or interventions, rather non-pharmacologic means.

I always tell my students and residents rotating with me that palliative medicine is a multidisciplinary approach and to respect and incorporate everyone’s ideas, from the doctors and social workers to the patients themselves.

What is your biggest project at the moment?

Currently, I am working on developing more palliative pharmacy educational symposia, establishing relationships with other universities, and exploring the not-for-profit sector of smaller palliative and hospice programs, all within the geographic Middle East, and more specifically in Egypt.

Is there anything we haven’t spoken about that you would like to add?

I just want to express my gratitude to all my mentors who supported and encouraged me. I am really happy and humbled that I have found a path that lead me to work with vulnerable patients and their families with limited choices and make a positive impact in their lives.

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