Hospice Story: Psychosocial Support & Medications – Permission

When pharmacy is consulted on a hospice patient the knee jerk response is let’s give them medications! That’s an understandable response considering the role of the pharmacist and often where the inquiry begins. However, I have always asked and taught, though the pharmacist isn’t often the one preforming psychosocial support, they must inquire, understand, and encourage its place in the hospice journey. So, it’s not uncommon to hear me ask things like, is the spiritual counselor or social worker visiting? What’s their take on the situation. The mind is powerful and can sometimes overcome a medication regimen. In this next mini-series, I’ll touch on some cases where the relationship between psychosocial support and medications are showcased.

It was approximately around 7pm when my cell phone rang. It was a dear friend who I’ve known for years and taught with at The Ohio State University. I knew their family had a parent on hospice and was at the local inpatient unit, so the call didn’t surprise me. The conversation didn’t start with typical pleasantries, but instead was met with panic and stress in their voice. The conversation went like this: “Dad’s just not responding to medications. They are giving him stuff, but it’s just not working. He seems so uncomfortable, was hoping I could pick your brain on what we might try next.” After some history gathering and getting up to speed, we discussed the current regimens and I asked this question, “Has everyone in the family visited? Anyone from out of the area you’re waiting on?” Clearly, this question was not expected as the silence on the other end made me think the phone call had dropped. Nonetheless, their response was everyone was or had been there, except one brother who was on his way right now. He would probably arrive within the next couple of hours. My response was your medication regimen seems appropriate and you’ve done the right titrations. Based on what you’re saying and how you’re chasing these symptoms, if I can be honest, it sounds like emotional discomfort and I have to wonder if it’s not related to the brother who has not arrived yet. My dear friend paused and said “well maybe, they are close”. I suggested since he was enroute let’s regroup after he arrives and see what, if anything, changes. They agreed.

We stayed in touch over the next day and my friend’s father had settled down greatly after the brother visited, no major medication changes had been needed and everything was stable. Now with this new found calmness, the family started to wonder how long would their father ‘hang on’. My friend called and said “hey, we just spoke with the social worker here in the inpatient unit and they said dads on his journey and could be any time now, but it’s been two days without any meaningful connection/response. It seems like he’s just hanging on. Do you have any thoughts?”

We talked about their dad settling down quickly once all the family was there. I reminded them how close of a family they are and asked the following “has everyone given him permission to go? Let him know you all love him and the family will stick together and take care of each other and cherish all he has taught the family?” My friend said no they haven’t done that. I suggested they get together, discuss it, and decide if they felt comfortable doing that.

I received a phone call later that day. My friend said their dad passed away 30 minutes after they all gave him permission to go. The family was at peace and so was their dad.

Note: This is part 1 of the psychosocial support & medications mini-article series.