Pharmacopalliation may look like an imposing word, and the fact that it has seven syllables makes it even more impressive, but its medical application is far simpler than its pronunciation might suggest. In essence, pharmacopalliation consists of the collection of efforts to treat symptoms of any disease or affliction by pharmacological methods, i.e. through medication or drugs. Most commonly, these kinds of treatment programs are associated with patients who are in the advanced stages of an illness, often in a hospice setting, and among all diseases, cancer is one of the primary afflictions.
Dr. Dawn Lockman, PharmD and Clinical Assistant Professor in Hospice Care and Palliative Care at the University of Iowa points out that the practice is not limited to simply treating symptoms on the basis of prior history, which might suggest that it’s the correct treatment program. In her view, pharmacopalliation must involve a comprehensive review of every single medication a given patient is ingesting, and a determination needs to be made about whether the benefits imparted to the patient by that medication outweigh any side-effects or other negatives.
Often enough, patients are prescribed drugs simply on the basis of precedence, which simply means that a particular disease has always been treated by a specific drug. Even worse, a patient can be continued on one or more drugs just because he/she has been taking them for a long period of time, and no one takes the time for a critical review to see if they’re really still necessary. In some cases, drugs with only marginal value to a patient are prescribed indefinitely for just this reason.
Rational pharmacopalliation seeks to eliminate treating patients with drugs simply because that’s always been the way it was done, or because certain drugs have always been part of the patient’s treatment regimen. Instead, rational pharmacopalliation adopts a patient-centered approach which involves careful consideration of the actual medical benefit delivered to a patient, and whether that benefit is truly worthwhile. It also involves close observation of the patient, so as to determine whether a given treatment is achieving any worthwhile medical benefit or pain reduction. There is no justification for continuing a medication just because it doesn’t make things worse.
The step-by-step approach to rational pharmacopalliation is therefore managed like this:
- Conduct a thorough assessment of the patient’s symptoms – In cancer patients, for example, one of the most prevalent symptoms will be severe pain, often at a specific location in the body. This assessment must take into account the patient’s physical condition and the specific stage that the disease is at.
- Formulate a personalized approach – Regardless of what may have worked for other people in the past, or what this particular patient has been treated with in the past, a personalized plan for treatment needs to be developed. This should be founded only on the observable symptoms, as well as what the patient communicates to caretakers. The guiding principle should be, “Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does”.
- Execute the customized plan – This stage of the process involves carrying out the plan developed in Step 2 and includes an important follow-up component. Any of the drugs which were decided upon in the patient-tailored plan are monitored closely in this phase, to note whether or not they are providing value to the patient. If any modifications to the plan are necessary, these are adopted at this time, and more careful observation is necessary to determine their effectiveness.
The fine points of pharmacopalliation
The above process may seem simple enough, but there is generally more to it than that, and that’s why there is a growing trend in the medical field toward what’s being termed ‘precision pharmacopalliation‘, where the process becomes even more refined. That refinement takes treatment to an even higher level, while still being completely patient-centered:
- Precise medical regimen – all drugs prescribed in conjunction with palliative care are issued in the precise types and dosages indicated, so as to maximize benefit and minimize patient burden.
- Monitor and evaluate drug-related issues – this means ascertaining whether some drugs are unnecessary or inappropriate, determination of correct dosage, advisability of additional medication, and observance of any adverse reactions to the program of treatment.
- Administration by knowledgeable practitioner – the guiding practitioner in precision pharmacopalliation must be someone who understands the difference between abrupt discontinuance of medication and tapering off, must be able and willing to explain the details of this precision approach to both patients and families, and must base all decisions solely on what is in the patient’s best interests.
Palliative care in the past may not have received its proper due, in terms of customizing care for individual patients, and instead has had more of a one-size-fits-all reputation, since the patients involved are generally in the final stages of life, and recovery is not usually anticipated. However, there are now many professionals in the medical field who believe that precision pharmacopalliation is a much more appropriate way to deliver patient-centered care to individuals with advanced illnesses.