OBJECTIVES: The inclusion of pharmacists as members of the team in hospice/palliative care has the potential to improve clinical outcomes and demonstrate cost savings, particularly in pain management. Accordingly, guidelines from the American Society of Health-System Pharmacists (ASHP) recommend pharmacist involvement in end-of-life care. The objective of the current study was to describe the impact of pharmacists on pain management in hospice/palliative care.

METHODS: A systematic literature review using the PRISMA guidelines was designed to search articles in PubMed, Scopus, and Embase between 2010-2019. Articles were identified using a search strategy encompassing relevant MeSH, index and key terms (e.g. pharmacist, pharmacist services, pain, pain management, and hospice care). Inclusion criteria were studies discussing pain management in hospice/palliative care detailing the impact of pharmacist intervention. Impacts assessed include clinical, cost or interventional outcomes such as therapy recommendations, dosage modifications, prevention of adverse events, or cost-effectiveness. Studies focused on pediatric hospice care, non-English articles and conference abstracts were excluded. The review was conducted using the Covidence web application.

RESULTS: A total of 13 articles were identified to meet inclusion criteria for qualitative analysis. Selected studies included seven (54%) prospective evaluations of the impact of a clinical pharmacist on patient pain control, four (31%) retrospective assessments of pharmacist-led interventions, and two (15%) surveys regarding pharmacist contributions to hospice care services. The pharmacist’s involvement in a multidisciplinary hospice care team had a positive impact on both clinical (reduction in pain intensity scores, symptom scores and recommendation of new effective treatments) and cost outcomes.

CONCLUSIONS: This systematic review demonstrates the benefit of pharmacist inclusion in hospice and palliative care services, with evidence for improvement of pain and symptom management and cost-effectiveness of treatment rendered.