Curriculum changes, reorganization, and philanthropic support are distinguishing pharmacists and spurring inclusion on palliative care teams.
Early in his tenure, Dean Donald Letendre realized a critical lack of palliative care offerings in the UI College of Pharmacy curriculum. “I came to believe strongly that the shortcoming in providing clinical education and training covering the full spectrum of life needed addressed,” he said. “Pain management and palliative care are fundamentally important to providing a comprehensive clinical foundation for all students.”
With that vision in mind, James Ray, clinical associate professor and the James A. Otterbeck OnePoint Patient Care Professor in Hospice and Palliative Care, was recruited in 2015. Today, under its new umbrella called the SOLACE Palliative Care Collaborative, faculty continue developing and implementing innovative teaching in whole-person care for people living with complex illness. SOLACE’s mission is to prepare current and future pharmacists to provide compassionate care and engagement in scholarship, outreach, and advocacy to improve the care of people with serious illness. Continued growth is expected thanks to a generous gift from former University of Iowa Hospitals & Clinics (UIHC) patient Pat Redlinger.
Multifaceted Approach
“We are training student and resident pharmacists to look beyond the medication profile and physical symptoms of disease and incorporate the practical, psychological, and spiritual domains to relieve suffering and promote living well in the face of serious illnesses,” said Ray.
Working alongside Ray within the Pharmacy Practice and Science Department is Kashelle Lockman, clinical assistant professor. In 2019, Lockman was the first pharmacist selected for Cambia Health Foundation's Sojourns Scholars Leadership Program, which aims to identify and advance the next generation of palliative care leaders.
Clinical assistant professors Lorin Fisher and Michelle Schmidt were hired in 2020 and 2022, respectively, to expand the palliative care faculty. Besides teaching responsibilities, Fisher is a clinical pharmacy specialist for UIHC’s Outpatient Supportive and Palliative Care Clinic, while Schmidt serves the same role for UIHC’s inpatient service. They are involved daily with patient care and precepting students, residents, and other learners.
According to the Center to Advance Palliative Care, only 8.6% of palliative care teams include a palliative care pharmacist. In 2016, the College began focused efforts to overcome this sparse number by integrating palliative care into the PharmD curriculum. Since then, nearly 600 students have spent 50 required hours across eight courses learning its principles: 18 in nonpain care and 32 in pain management. Beginning in 2017, five additional palliative care electives encompassing 16 credit hours have been available, with 241 unique students having taken at least one course.
“We are training student and resident pharmacists to look beyond the medication profile and physical symptoms of disease and incorporate the practical, psychological, and spiritual domains to relieve suffering and promote living well in the face of serious illnesses.”
-James Ray, James A Otterbeck OnePoint Patient Care Professor in Hospice and Palliative Care
That same year, a university-approved Palliative Care Certificate was instituted for PharmD students, with goals to prepare graduates as palliative care champions in their work setting and community, and to integrate palliative care principles into any pharmacy practice – whether community pharmacy, long-term care, or a hospital. The UI is one of just two pharmacy schools nationwide to offer this credential. Thirty-six students have earned the certificate, which also sets up graduates to participate in residencies and fellowships if they desire to acquire specialized training in the area.
“The College is dedicated to ensuring its graduates understand the meaning of medications to the patient and important people in their life to address serious health-related suffering by infusing their pharmacy practice with both humanity and science to provide whole-person care,” said Lockman.
Results are being seen beyond the UI campus, something Ray and Lockman anticipated when they launched the certificate. Students who have participated in the certificate program reported feeling they have better career opportunities after graduation, even if their first job isn’t in palliative care.
“We believe this is largely because employers are impressed with graduates who have pursued expertise and also curious about palliative care coursework, especially since it is still relatively new,” said Ray.
That was the experience of Jillian Ginger, '19 PharmD, who used her palliative care education in a residency at Unity Point Des Moines. “Having the certificate on my CV gave me something interesting to talk about during interviews,” said Ginger. “I had a unique experience, including patient interactions, that other candidates didn’t have, and I know it helped me,” added Ginger, who went on to garner a leadership position with the organization’s pain management, palliative care, and opioids stewardship area – a move she credits to the certificate.
Valued Team Member
Beyond the PharmD curriculum, the College began offering a PGY2 Palliative Care and Pain Management Residency (PCPM) in 2017. The program provides an interprofessional partnership with the UIHC Hospice and Palliative Medicine Fellowship, fostering collaborative direct-patient care with the pharmacist as an integral interprofessional palliative care team member.
“The expertise pharmacists provide is a valuable piece of patient evaluation,” said palliative medicine physician Bryan Struck, who became director, UIHC Supportive & Palliative Care in October. “Having multiple disciplines caring for a patient is key to doing palliative care well, in terms of managing symptoms and meeting patient goals.”
It’s partially through the PCPM pharmacy residency that Pat Redlinger’s gift came about. Redlinger, who died from ovarian cancer in 2021, was a recipient of the holistic approach provided by palliative care.
“It’s been a great value to have palliative care pharmacists on the team. I always had pharmacists that came over and talked with me in the chemo unit, but it wasn’t at the level (my palliative care pharmacist) went over things with me,” said Redlinger during treatment. “She is very detailed, and very caring (and knows) how I want to be treated, which gives me comfort.”
Redlinger was referring to Jennifer Ku, the College’s 2018-19 PCPM resident. “Pat was one of the first patients I saw independently in the palliative care clinic. She always had a mindset of education and was very inquisitive,” said Ku, now a pharmacist in Neurology and Palliative Care with Providence St. Peter Hospital in Olympia, Washington. “She loved having trainees helping her navigate cancer’s challenging landscape and would try to schedule her appointments when fellows and residents were in clinic. I built trust by taking time to explain things, such as a medication switch.”
Katie Melton, a Hospice & Palliative Care physician with VA Pacific Islands Healthcare System, was a UIHC Hospice and Palliative Medicine fellow alongside Ku. “Pat pushed me to be the best possible palliative care physician I could be. Her wisdom, teaching, and spirit confirmed I had chosen a fulfilling career path, where I could truly see the impact my care has on the lives of my patients and their loved ones,” said Melton.
The experience also reinforced why an interprofessional team is paramount. “I strongly believe that a palliative care doctor without help is not nearly as successful as one coming from a team to help support these complex patients,” said Melton. “The pharmacist ensured I was updated on the latest treatment strategies and that my medication recommendations appropriately weighted risks versus benefits. I currently do not have a pharmacist working (with) me and sometimes second-guess my initial instincts. Having a pharmacist on the team enhances prescribing confidence and helps free the physician to better attend the patient/family’s psychosocial needs.”
Supporting this cooperative method was Redlinger’s desire, according to Timothy Thomsen, retired physician and former UIHC Supportive & Palliative Care director. He got to know Redlinger well and she designated him to decide how her donation should be dispersed. “Pat recognized the importance of having a multidisciplined collaborative approach to care. Giving the money to the College of Pharmacy palliative care programs and its SOLACE initiative demonstrates the appreciation and commitment UIHC has to nurturing its connection with palliative care pharmacists.”
Building on Success
Through the Sojourns Scholars Leadership Program, Lockman is leading efforts to expand palliative care educational opportunities beyond Iowa.
“Time and again, as faculty and palliative care pharmacists, we see how educating and training current and future pharmacists in palliative care transforms the care of people living with serious illness,” said Lockman. “Most of our residents to date had little to no experience in palliative care prior to beginning the PGY2 PCPM residency, as most pharmacy schools don’t yet have faculty specializing in palliative care.”
Lockman and Schmidt, in collaboration with a national team of palliative care and hospice pharmacists, developed 15 entrustable professional activities for palliative care specialist pharmacists that will serve as guidance and support for existing and future pharmacists in these specialties. Additionally, Lockman is developing a palliative care curricular toolkit for colleges and schools of pharmacy worldwide, with a goal to more broadly increase pharmacy students’ exposure to palliative care. The Redlinger gift will further support these and additional SOLACE Palliative Care Collaborative initiatives to ensure more people living with cancer and other serious illnesses receive holistic, person-centered care from collaborative interprofessional palliative care teams that include a specialist palliative care pharmacist.
“I am extremely pleased and proud of the efforts of faculty whose teaching and scholarship is centered on palliative and end of life care,” said Letendre. “Our future is exceptionally bright because of the tremendous contributions of our faculty in this domain of care. And I have no question, that as a result of their efforts, our College will continue to be among the nation’s leaders in this area of practice.”
To help palliative care education in the UI College of Pharmacy, donate through https://givetoiowa.org/phcare.