People managing cancer and comorbid conditions use medicines throughout the disease trajectory. Little is known about the support they receive for medication management. This study asked, what are the shared experiences of pharmacists caring for people with cancer? This paper unpacks the concept of inattentional blindness that emerged from the study; inability to detect unexpected objects to which we aren’t paying attention. It describes types of drug related problems (DRPs) encountered, how they are resolved, and highlights service gaps.
Semi-structured in-depth interviews were conducted with a purposive sample of Registered Pharmacists working in primary and/or specialist cancer care. Interviews were transcribed in full and thematically analysed. Nineteen pharmacists ranging in practice profiles were interviewed. Thematic saturation was achieved.
Three categories of DRPs were described: potential, multifaceted and actual problems. Potential DRPs were commonly identified by specialist pharmacists through systematic clinical pharmacy processes and by the cancer multidisciplinary team. Potential DRPs were considered easy to resolve if managed within the hospital. Multifactorial DRPs were less commonly described. Identification did not depend on setting of care but on the pharmacist conducting an in-depth consultation utilising a patient-centric approach. Multifactorial DRPs were complex, involved medicines administered in patients’ homes and crossed boundaries of care. They were universally considered challenging to resolve. Actual DRPs were frequently encountered by community pharmacists and specialist cancer pharmacists. Actual DRPs related to adverse drug effects or drug interactions not proactively managed. Community pharmacists resolved these directly with patients through self-management. Actual DRPs encountered in specialist care were managed acutely within the hospital environment.
Proactive management of potential DRPs within the acute treatment phase is the primary focus of pharmacy services in cancer. Despite their availability and skillset, primary care pharmacists have limited experiences identifying and managing DRPs in cancer. Resultant service gaps manifest as actual DRPs.