Retrospective analysis of pharmacist interventions in an ambulatory palliative care practice

J Oncol Pharm Pract. 2016 Dec;22(6):757-765. doi: 10.1177/1078155215607089. Epub 2015 Oct 1.


Background: We have previously reported the development of an outpatient palliative care practice under pharmacist-physician collaboration. The Doris A. Howell Service at the University of California, San Diego Moores Cancer Center includes two pharmacists who participate in a transdisciplinary clinic and provide follow-up care to patients.

Objective: This study evaluated pharmacist interventions and patient outcomes of a pharmacist-led outpatient palliative care practice.

Methods: This was a retrospective data analysis conducted at a single, academic, comprehensive cancer center. New (first visit) patient consultations were referred by an oncologist or hematologist to an outpatient palliative care practice. A pharmacist evaluated the patient at the first visit and at follow-up (second, third, and fourth visits). Medication problems identified, medication changes made, and changes in pain scores were assessed.

Results: Eighty-four new and 135 follow-up patient visits with the pharmacist occurred from March 2011 to March 2012. All new patients (n = 80) were mostly women (n = 44), had localized disease (n = 42), a gastrointestinal cancer type (n = 21), and were on a long-acting (n = 61) and short-acting (n = 70) opioid. A lack of medication efficacy was the most common problem for symptoms of pain, constipation, and nausea/vomiting that was identified by the pharmacist at all visits. A change in pain medication dose and initiation of a new medication for constipation and nausea/vomiting were the most common interventions by the pharmacist. A statistically significant change in pain score was observed for the third visit, but not for the second and fourth visits.

Conclusions: A pharmacist-led outpatient palliative care practice identified medication problems for management of pain, constipation, and nausea/vomiting. Medication changes involved a change in dose and/or initiating a new medication. Trends were observed in improvement and stabilization of pain over subsequent clinic visits.

Keywords: Pharmacist; oncology; pain clinic; palliative.

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care / methods*
  • Analgesics / therapeutic use
  • Analgesics, Opioid / therapeutic use
  • Cooperative Behavior
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pain Management / methods*
  • Palliative Care / methods*
  • Pharmacists*
  • Physicians
  • Professional Role*
  • Retrospective Studies


  • Analgesics
  • Analgesics, Opioid