A Systematic Review of Palliative Care Content in the Doctor of Pharmacy Curriculum

Jennifer A. Pruskowski, PharmD; Ravi Patel, PharmD; Kristine Nguyen; CeJae Scolese; Michele Klein-Fedyshin, MSLS; Gayle Brazeau, PhD

Disclosures

Am J Pharm Educ. 2021;85(6):8468 

In This Article

Abstract and Introduction

Abstract

Objective: To describe the methods of teaching and evaluating palliative care experiences for pharmacy students.

Findings: A literature search retrieved 971 reports, from which 26 studies met all of study criteria. Educational interventions concerning palliative care included didactic courses, flipped classrooms, advanced pharmacy practice experiences (APPEs), workshops, and seminars. Total direct hours of education in palliative care ranged from 1–200. Seven (27%) focused experiences were reported as required, while nine (35%) were reported as elective. The majority (n=14, 54%) of studies measured pharmacy students' confidence, attitudes, or perceptions as the main outcome, and of those most studies reported an improvement. Five (19%) studies reported on interprofessional experiences in palliative care conducted in the United States, and four (15%) studies reported on similar experiences conducted outside the United States. When reported, most experiences were developed for students to complete prior to beginning their APPE year. All of the included studies used a non-randomized design.

Summary: This review suggests a palliative care experience for pharmacy students should be interprofessional, occur during the year prior to APPEs, and measure skills-based outcomes.

Introduction

Palliative care is a growing need within today's health care landscape. The World Health Organization (WHO) defines palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." According to the WHO's Global Atlas of Palliative Care at the End of Life, currently 20 million people worldwide would benefit from palliative care.[1] This number will only increase given an aging population combined with increased chronic diseases. For example, the Administration on Aging predicts that by the year 2030 there will be more than 72 million Americans over 65 years of age, and the Center to Advance Palliative Care estimates that at least six million of those would benefit from palliative care.[2,3]

One challenge in addressing the need for palliative care is the limited number of pharmacists involved in this type of practice.[4] According to the National Palliative Care Registry, in 2018 only 36 (8.6%) inpatient palliative care programs reported a pharmacist as part of their team.[5] One driver for this low prevalence may be the insufficiency in professional doctoral education. A 2013 survey-based study noted that schools and colleges of pharmacy devote on average only six hours of curriculum time to palliative care education.[6] Considering the total hours of didactic and experiential education that a typical student pharmacist receives within a professional degree (minimum 128 credit hours), the six hours spent on palliative care accounts for less than 1% of the total curriculum. This is significantly less than what medical students receive, which is on average 12 curricular hours of material.[7] In addition, to date only the Universities of Colorado, Iowa, Maryland, and Pittsburgh offer specialized certificate or equivalent programs for future pharmacists interested in palliative care.

Incorporating palliative care focused experiences into the Doctor of Pharmacy (PharmD) curriculum benefits student pharmacists, pharmacy schools, and the pharmacy profession overall. Even if student pharmacists do not choose to specialize in palliative care, the knowledge, skills, and perspectives gained from a palliative care-focused experience have been shown to improve students' attitudes towards end of life situations and decrease professional burnout.[8,9] Palliative care experiences will also improve the school's ability to meet Accreditation Council for Pharmacy Education (ACPE) Standards 2016.[10] While not explicitly stated in Standards 2016, Appendix B of the 2011 Standards acknowledges the importance of including palliative care and principles of end-of-life care in the clinical science curricular content.[11] Palliative care experiences can also provide novel ways to introduce interprofessional learning to pharmacy students as the essential element in the provision of palliative care is an interprofessional team. Finally, incorporating these experiences will elevate the Doctor of Pharmacy curriculum to the curriculum of other health science programs. A 2019 commentary noted that more than 900 peer-reviewed articles describing the palliative care education of physicians are available, while only 21 involving the education of pharmacists have been published.[12]

Incorporating and evaluating palliative care focused education and patient care experiences will be challenging given curriculum hours are often stretched, and previous systematic reviews on this subject have not focused on pharmacy.[13–18] Therefore, the purpose of this systematic review was to describe methods of teaching and evaluating palliative care experiences for pharmacy students. The goal of this systematic review was to provide guidance for schools and colleges of pharmacy looking for initial steps to incorporate palliative care education and focused experiences into their curriculums.

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