Scanlan, Justine Claire; (2002) Pharmaceutical care of cancer patients: A multidisciplinary perspective. Doctoral thesis (Ph.D.), University College London.

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Abstract

Introduction: The past decade has seen considerable alterations to how health care is delivered in the United Kingdom. Patients are discharged from the hospital sooner (DOH, 1990), often with a higher degree of dependency on health care professionals (HCPs) than previously. Although some see this movement in health care delivery as a cost saving exercise, cancer patients (often ill for long periods) prefer to stay at home for as long as possible (Bergen, 1991). In recent publications (DOH, 2000a; DOH, 2000b), the need for good communication between primary and secondary professionals and cancer patients about all aspects of their care has been emphasised. Methods: Semi-structured, qualitative interviews were conducted with cancer patients and HCPs. The patients were purposively selected from those attending a London teaching hospital, to ensure type and diversity of cancer. HCP groups with pharmaceutical input into cancer patients' care were identified for inclusion in the study from the literature review and patient interviews. HCPs were chosen to ensure diversity in grade and experience. Patients were interviewed twice, in the hospital and approximately six weeks after discharge. HCPs were interviewed once. The interviews were tape-recorded and transcribed verbatim. Content analysis was used to identify and map the nature and range of the factors involved. Results and Discussion: Interviews were held with 52 patients and 63 HCPs (9 hospital doctors, 11 general practitioners, 12 hospital, 12 district and 7 Macmillan nurses, 2 hospital and 10 community pharmacists). The drug related problems (DRPs) experienced by cancer patients were identified. Reasons for the occurrence of DRPs are explored. Pathways mapping the systems of pharmaceutical care delivery are described. The strengths and weaknesses of these systems are documented and recommendations made regarding how improvements can be made. Conclusion: Cancer patients experience DRPs. Deficiencies in communication between patients and HCPs and between professional groups contribute to their occurrence. HCPs need to recognise the interdependency of their roles and the need for efficient co-ordinated communication systems within the health care system if cancer patients are to avoid receiving fragmented pharmaceutical care.

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