Although most pharmacy schools include some form of death education in their curricula, studies have shown that the vast majority of pharmacists do not feel prepared for end-of-life conversations with patients and their families, according to a presentation at the Hematology/Oncology Pharmacy Association’s annual meeting.
Robert Mancini, PharmD, BCOP, FHOPA, coordinator of the Bone Marrow Transplant Pharmacy Program at St. Luke’s Cancer Institute in Boise, Idaho, presented “Thanatology for Oncology Pharmacists: Education in Practice” to discuss the importance of learning and using thanatology strategies to help patients near the end of life, better cope with loss on the job, and prevent burnout. He said the approach can help students, residents, and practitioners in many disciplines and at any career stage.
Dr. Mancini encouraged practitioners to study death, dying, grief, and loss academically and then apply those principles at work. “Death competence is skill in tolerating and managing clients’ problems related to dying, death, and bereavement,” he said. “We are all death educators—and we never stop teaching.”
Each person has his or her own personal beliefs, feelings, and experiences related to death, and those personal characteristics can detract from or enhance our ability to be empathetic and effective with patients.
For example, death is surrounded by religious and ethical implications, which may affect our perception of whether a person has “good death,” decisions about euthanasia or organ donation, willingness to accept treatments such as analgesia or nutrition, and whether a patient prepares for death.
Healthcare providers also may experience feelings about death that are related to guilt or blame, such as questioning their medical decisions or feeling as if they failed to cure someone. All of these factors may contribute to healthcare provider burnout, which research has shown affects the majority of oncology pharmacists.
Dr. Mancini said that in order to reduce anxiety and be prepared to support patients at the end of life, pharmacists and other healthcare providers must seek mentoring relationships and education. Resources include established programs such as the Healer’s Art and the Association for Death Education and Counseling. He suggested that programs and institutions:
· assign readings (for example, scientific research, patient perspectives, philosophical and ethical analyses)
· make sure that employees know that counseling is available, accepted and encouraged.
· schedule open team discussions on the topic.
· provide opportunities for people to shadow chaplains, social workers, or other providers during difficult conversations
“We must remind ourselves of meaning and purpose. It’s about finding meaning and understanding your feelings,” he said. “It’s OK to feel, to cry, to be sad. It’s OK to cry one day and laugh the next. It’s ok to take a break. It’s OK to talk about it with family, with colleagues.”