Pediatric palliative care in interface with clinical pharmacy service: scenario analysis in a University Hospital in Bahia
DOI:
https://doi.org/10.30968/jhphs.2025.164.1178Abstract
Objective: To analyze the scenario of pharmaceutical activities in Palliative Care developed in a Pediatric Center of a University Hospital in Salvador, Bahia. Methods: This is a descriptive cross-sectional study, carried out based on information present in medical records during the period from June 2018 to June 2020. As long as they were monitored by the Clinical Pharmacy Service, patients eligible for Palliative Care were characterized regarding their age, sex and main disease. Pharmaceutical procedures were categorized and interventions, if detected, were associated with the respective Medication-Related Problem. The medicines were classified using Anatomic Therapeutic Chemical, indicating whether they were used off-label. Results: Of the 370 patients selected, 31 were included in the study, as they had clinical monitoring from the pharmacist. Of these, 17 (54.84%) were male, with an average age of 6.19 years, ranging from 10 days to 18 years. The most frequent diagnoses were endocrine, nutritional and metabolic diseases (8; 25.80%). Pharmaceutical procedures included detection of adverse events (12; 19.04%), additional monitoring (2; 3.17%), guidance to the family or team (13; 20.63%) and interventions (36; 57.14%). The interventions were mainly related to safety (13; 36.11%). Of the prescribed medications, 91 (23.09%) were systematized in the alimentary tract and metabolism in the ATC, followed by nervous system (85; 21.57%) and antimicrobials for systemic use (61; 15.48%) 30 off-label prescribed items were identified, 3 of which were associated with suspected adverse reactions. Conclusions: The study identified limited pharmaceutical service, covering only 8.37% of the population analyzed. These results highlight the importance of expanding the integration of pharmacists into multidisciplinary palliative care teams to improve the quality of life of these patients. It is important to consider that, given that this is documentary research, memory and recording biases must be considered. These results are expected to foster improvements in this context, including the provision of a dignified quality of life from diagnosis onward, uniting voices so that this science ceases to be, in addition to being underutilized, synonymous with the end of life.
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References
1. Costa RP, Misoczky MC, Abdala PRZ. Do dilema preventivista ao dilema promocionista: retomando a contribuição de Sérgio Arouca. Saúde Debate. 2018;42(119):990-1001. doi:10.1590/0103-1104201811916
2. World Health Organization. Cancer pain relief and palliative care: report of a WHO expert committee. Geneva: WHO; 1990
3. Cancer Control: Knowledge into Action: WHO Guide for Effective Programmes. Geneva: WHO; 2007.
4. Pyke-Grimm KA, Fisher B, Haskamp A, et al. Providing Palliative and Hospice Care to Children, Adolescents and Young Adults with Cancer. Semin Oncol Nurs. 2021;37(3):151166. doi:10.1016/j.soncn.2021.151166
5. Cipolotti R. Cuidados paliativos: histórico, definição e contextualização. In: Tratado de Pediatria. São Paulo: Monole; 2014.
6. García-López I, Cuervas-Mons Vendrell M, Martín Romero I, et al. Off-label and unlicensed drugs in pediatric palliative care: a prospective observational study. J Pain Symptom Manage. 2020;60(5):923-932. doi:10.1016/j.jpainsymman.2020.06.014
7. Academia Nacional De Cuidados Paliativos (Brasil). Manual de Cuidados Paliativos. Rio de Janeiro: ANCP; 2009.
8. Wannmacher L. A ética do medicamento: múltiplos cenários. In: Uso Racional de Medicamentos: Temas Selecionados. Brasília: OPAS; 2012.
9. Franken LG, de Winter BC, van Esch HJ, et al. Pharmacokinetic considerations and recommendations in palliative care, with focus on morphine, midazolam and haloperidol. Expert Opin Drug Metab Toxicol. 2016;12(6):669-680. doi:10.1080/1742-5255.2016.1179281
10. Giangreco NP, Elias JE, Tatonetti NP. No population left behind: Improving paediatric drug safety using informatics and systems biology. Br J Clin Pharmacol. 2022;88(4):1464-1470. doi:10.1111/bcp.14705
11. Elzagallaai AA, Rieder MJ. Genetic markers of drug hypersensitivity in pediatrics: current state and promise. Expert Rev Clin Pharmacol. 2022;15(6):715-728. doi:10.1080/17512433.2022.2100345
12. Adisa R, Anifowose AT. Pharmacists’ knowledge, attitude and involvement in palliative care in selected tertiary hospitals in southwestern Nigeria. BMC Palliat Care. 2019;18(1):107. doi:10.1186/s12904-019-0492-8
13. Hossain E, Rana R, Higgins N, et al. Natural language processing in electronic health records in relation to healthcare decision-making: a systematic review. Comput Biol Med. 2023;155:106649. doi:10.1016/j.compbiomed.2023.106649
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