Introduction
Patients with advanced cancer have a median of 6-8 symptoms (1), many of which will be managed pharmacologically. A recent study indicated that most palliative care patients do not adhere to their prescribed regimen (2). To date no evaluation of the pharmaceutical needs of this group of patients has been carried out. The aim of this study is to develop a system to assess these needs.

Method
A systematic review of the literature was carried out to identify factors important in pharmaceutical care needs assessment of palliative care patients. Using a two round Delphi technique (3,4), a panel of pharmacists scored the factors for relevance in identifying patients pharmaceutical care needs (1= not relevant at all, 9= very relevant) and provided comments. Factors with a median score of 7-9 and no disagreement (> 80% of panel scoring 7-9) were included in the criteria for the assessment tool. All other factors were excluded. Factors with a median score of 8 or 9 were taken to be reliable. The criteria selected were then used to construct an assessment tool. Panel members reviewed the tool ensure comprehensiveness.

Preliminary results and discussion
The literature search produced 76 factors that could potentially contribute to assessment of pharmaceutical care of palliative care patients. After the first and second scoring exercises 56 (74%) factors were identified as relevant assessment criteria (see table 1). Of these, 52 (93%) had a median score of 8 or 9 making the chosen criteria reliable. The highest level of agreement was achieved on those criteria relating to appropriateness of current medication, medicine storage and to a lesser extent medicines management. A total of 20(26%) factors were excluded from the assessment criteria, the majority of these being related to the patients condition.

Table 1

* of total number identified **of number identified initially for category

The assessment tool developed generated a total of 28 comments from the panel members; 12 seeking elucidation, 7 about formatting, 6 suggesting additions. Eight changes were made. The Delphi method used provides an assessment tool with face validation. Further validation of the tool is constrained by the lack of standard tool with which to compare the developed system. Concurrent validation will need to involve external expert validation and will also be subject to information from a semi-structures interview with patients.

Reference:

1. Curtis EB, Krech R Walsh TD. Common symptoms in patients with advanced cancer. Journal of Palliative Care 1991;7(2):25-9
2. Zeppetella G. How do terminally ill patients take their medication? Palliative Medicine 1999; 13(6):469-75.
3. Bowling A. Research Methods in Health. Investigating Health and Health Services. Buckingham. Philadelphia: Open University Press; 1997.
4. Campbell SM, Cantrill JA, Roberts D. Prescribing indicators for UK general practice: Delphi consultation study. BMJ 2000;321:425.