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Can J Hosp Pharm. 2010 Jan-Feb; 63(1): 56.
PMCID: PMC2832574

Palliative Pharmacy Care

Reviewed by Gerri Scott, BScPharm, FASCP

JM Strickland , editor.  American Society of Health-System Pharmacists,  Bethesda, Maryland,  2009. Softcover, 227 pages. ISBN  978-1-58528-165-7.  US$80.00 (US$64.00 for ASHP members). 

By providing a “blending of published literature, unpublished data, and expertise”, the editor intends this book to be “a practical approach to palliative care and the unique role of the pharmacist”. It is a resource for pharmacists who are new to palliative care, as well as those who wish to improve their knowledge and skills in this specialized area of practice.

The first section of the book, “The Palliative Care Spectrum: Providing Care across Settings”, addresses care for patients with a diagnosis of cancer, as well as those with a variety of other disease states that are sometimes overlooked. It also discusses palliation in various settings, including the pediatric and intensive care areas.

Other sections focus on individual symptoms such as anorexia and cachexia, anxiety and depression, agitation and delirium, dyspnea, fatigue, nausea and vomiting, constipation and diarrhea, secretion management, nutrition and hydration issues, and, of course, pain management. The chapters on pain and symptom management are set up in a format whereby the symptoms and pathophysiology are discussed first, followed by discussions of assessment and management. Often included are tables or charts summarizing causes or exacerbators of a particular symptom and treatment options, with recommended dosing. Both pharmacologic and nonpharmacologic treatments are discussed. “Key points” and “clinical pearls” are provided throughout the book; the chapters relating to pain and symptom management include case studies as well.

The final section of the book, “Beyond Drug Therapy: Key Issues for Pharmacists in Palliative Care”, deals with ethical issues, communication, research, establishing a palliative care service, and education.

Although this reviewer did find the book to be a valuable resource, it was somewhat less informative in certain aspects than other references that are now available. The recommendations for the management of symptoms and dosing charts are helpful, but not as comprehensive as those in some other references. In addition, the clinical pearls were a little disappointing; they were not really “clinical pearls” but often were more like an introduction to a specific topic. However, the suggestions for networking and listings of other palliative care resources, available trainee-ships, and further education are definitely valuable, and this information is often not readily available from other sources. Other interesting topics discussed were the ethical issues and advance directives. Also, I appreciated the focus on the role of the pharmacist as going beyond that which applies to the pharmaceutical realm. The book continually stresses that in the palliative care setting, the pharmacist has a role that encompasses several capacities, including supporting the family and caregivers, ensuring continuity of care, ensuring informed decision-making, attending to spiritual well-being, and supporting function. These roles are often overlooked by pharmacists but are very important, particularly in the palliative care setting. It should also be mentioned that because this is a US publication, there are some differences in medications, laboratory values, and possibly screening tools.

Articles from The Canadian Journal of Hospital Pharmacy are provided here courtesy of Canadian Society Of Hospital Pharmacists