ASHP statement on the pharmacist's role in hospice and palliative care.

The American Society of Health-System Pharmacists (ASHP) believes that pharmacists have a pivotal role in the provision of hospice and palliative care and that pharmacists should be integral members of all hospice interdisciplinary teams. Pharmacists practicing in U.S. health systems have been active in defining and providing palliative care since the introduction of hospice through a demonstration project supported by the National Cancer Institute and conducted in New Haven, Connecticut, between 1974 and 1977. Palliative care has been defined by the World Health Organization (WHO) as “the active total care of patients whose disease is not responsive to curative treatment.” WHO notes that control of pain, other symptoms, and psychological, social, and spiritual problems is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Pharmaceutical care is defined as the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life. Medication therapy is the cornerstone of most—but not all—symptom control in palliative care. The goals of palliative care and pharmaceutical care are consistent, with the latter being a necessary component of good palliative care. Hospice is a philosophy and program that delivers palliative care. Hospice care is provided by an interdisciplinary team, which provides expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s wishes. Emotional and spiritual support are also extended to the family of the patient. In U.S. hospice programs, care is usually provided in the patient’s home or in a home-like setting operated by a hospice program. Hospice and palliative care share the same core values and philosophies. The purpose of this statement is to describe pharmacist’s responsibilities and to promote understanding of the various ways in which pharmacists provide or contribute to the provision of care to patients who might be nearing the end of life.