A qualitative exploration of community pharmacists’ experiences of dispensing oral anti-cancer medications

Introduction

Oral anti-cancer medications (OAMs) have revolutionised cancer care. OAMs have a convenient route of administration, which avoid infection and extravasation risks, and injection site reactions associated with intravenous access. In Ireland, OAMs are dispensed from community pharmacies by community pharmacists who often have a lack of specialist training, insufficient access to patient notes, and prescriptions inadequate to clinically verify a patient’s treatment. No research has been conducted in Ireland on this topic since 2012.[1] The huge growth in OAMs since then means that the community pharmacy environment for dispensing OAMs have likely changed significantly.

Aim

To explore community pharmacists’ experiences of dispensing OAMs in Ireland and identify areas of improvement within the current system.

Methods

Semi-structured interviews were conducted with sixteen community pharmacists registered with the Pharmaceutical Society of Ireland who had dispensed OAMs in a community pharmacy setting. Participants were recruited through convenience (n=3), purposive (n=7), and snowball (n=6) sampling. Interview guides were developed from published literature. Interviews were conducted face-to-face or through Microsoft Teams and were recorded. Recordings were transcribed verbatim. The transcripts were analysed using an inductive thematic analysis approach using NVivo 12.

Results

The majority of participants were female (11/16), aged <40 years (11/16), and worked in a small pharmacy chain (2-9 pharmacies; 11/16). Only a quarter of participants had training in specific training about OAMs (4/16). There were three themes identified: ‘Patient Benefit’, ‘Communication’, and ‘Infrastructure’. Participants acknowledged that community pharmacists have strong relationships with their patients that facilitate an environment that aided counselling and eliciting patient queries. At the same time, it was noted that it is more difficult to monitor adherence of anti-cancer medications taken at home.

Communication with hospitals was identified as a barrier. Discharge information is often inadequate to verify prescriptions due to insufficient details on the prescription or poor legibility. This is compounded by the difficulty in contacting OAM prescribers.

On a systems’ level, community pharmacists feel that there is little support or training given to allow them to dispense OAMs. Participants found that only with time and experience in dispensing OAMs did they gain expertise and confidence.

Conclusion

Community pharmacists have an important role in the management of patients treating their cancer with OAMs; however, many feel that there are difficulties communicating with other healthcare professionals about potential OAM issues and that the infrastructure and resources are not in place to maximise the benefit to patients. Provision of OAM-specific training, provision of adequate discharge information, and ability to directly communicate with prescribers and/or oncology pharmacists would increase the competence and confidence of community pharmacists to dispense OAMs safely. This would reduce the risk of dispensing errors, missed supportive medications, and unrecognised adverse drug reactions.

References

1. Hammond L, Marsden E, O’Hanlon N, King F, Henman MC, Keane C. Identification of risks associated with the prescribing and dispensing of oral anticancer medicines in Ireland. Int J Clin Pharm. 2012 Dec 1;34(6):893–901.