Should palliative care be a pharmacy specialty?

Hospice and palliative care pharmacists push for specialty recognition




Should palliative care be recognized by BPS as a pharmacy specialty?

There's a movement afoot to get palliative care recognized as a specialty by the Board of Pharmaceutical Specialties (BPS), and Richard Bertin, Ph.D., executive director of BPS, is well aware of it. "The palliative care people are well on the way to having the criteria [for certification] met," he told Drug Topics.

For a pharmacy practice specialty to be recognized by BPS, a detailed petition must be submitted to the board for review. BPS has specific guidelines for petition completion, including seven criteria that must be addressed within each petition. The guidelines are available from BPS as well as at The criteria are summarized at right.

"The onus is certainly on the petitioning group," said Nancy Alvarez, Pharm.D., of Hospice Pharmacia. In this case, the petitioning group is a task force of 11 pharmacists, all of whom are volunteering their time to work on the project. Alvarez has been at the helm for about a year. "Our organization happens to be the group spearheading it," she added.

Getting a completed petition to BPS is a long and difficult process. Currently, the task force is gathering information to fulfill the "need" requirement of the petition. It has to show that palliative care is sufficiently different from the oncology and pharmacotherapy specialties to justify recognition. "We believe we will be able to show that," said Alvarez.

"Palliative care pharmacists are integral members of the interdisciplinary team," said Lisa C. Miller, Pharm.D. They are relied on heavily to provide "thoughtful and accurate information regarding medication choices, protocol [and] guideline development, and pharmacoeconomic choices," she said. Miller is pharmacy services manager at the Hospice of the Florida Suncoast and is also on the task force.

Miller asserted that palliative care requires a unique combination of pharmaceutical knowledge and communication skills. In particular, palliative care pharmacists must be adept at managing end-of-life drug therapy while maintaining communication with all of the individuals involved. She said these pharmacists need "a communication style that goes beyond patient counseling and encompasses family, staff, and caregiver issues as well.

"Many of the skills used by palliative care pharmacists are learned on the job or through continuing education," with more and more R.Ph.s obtaining advanced training in such care, Miller continued.

Pain management, a significant part of palliative care, has been garnering attention in the medical community. "There's just an awful lot of attention right now on the pathetic treatment of pain," said Calvin Knowlton, CEO of Hospice Pharmacia, R.Ph., M.Div., Ph.D. "It's a ubiquitous problem." Three thousand hospices and over 1,400 pain clinics exist to treat the millions of Americans suffering from chronic pain. According to Knowlton, 400 to 500 pharmacists work full-time in palliative care, with "a whole array of pharmacists dabbling in it."

The task force will need these pharmacists to help them meet BPS' third criterion. Information gathered from palliative care pharmacists will help to delineate this area of practice from those areas already credentialed. Compounding R.Ph.s, already experts on alternate routes of administration and individualized dosage forms, may also consider participating, as may pharmacists in academia.


The survey step is still some time off. Alvarez and company are busy raising $20,000-$40,000 for a task-analysis study. She estimated the entire petition project may cost upwards of $200,000. "It's expensive, but many people will benefit," she said.

The task force hopes to have a completed petition submitted to BPS in the fall of this year. BPS will then review it, conduct hearings, and issue a final ruling.

Jillene Magill-Lewis, R.Ph.

Based in the state of Washington, the author writes frequently on pharmacy-related issues.

Criteria for BPS recognition of a specialty

• There must be a need for pharmacists trained in the specialty.

• There must be a significant number of patients willing to pay for these specialized services.

• There must already be a significant number of pharmacists who spend most or all of their time in the practice specialty.

• The specialty must require specialized knowledge of pharmaceutical sciences, which is related to physical, biological, and behavioral sciences.

• The specialty must be distinct from other specialties already certified by BPS.

• Advanced training in the specialty area must already be available.

• There must be a "transmission of knowledge" via literature that is specific to the specialty (numerous published studies and journals that focus on the specialty, for example).

Adapted from "Procedures for Considering Petitions," published by BPS

Specialties currently recognized by BPS

• Pharmacotherapy

• Oncology

• Nutrition support pharmacy

• Psychiatric pharmacy

• Nuclear pharmacy


Jillene Lewis. Should palliative care be a pharmacy specialty?. Drug Topics 2001;3:39.