Allison Jennifer, Fisher Julie, Souter Caroline, Bennie Marion
NHS Lothian Pharmacy Service, Western General Hospital, Edinburgh, UK.
Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
J Oncol Pharm Pract. 2019 Dec;25(8):1933-1944. doi: 10.1177/1078155219841118. Epub 2019 May 1.
In the UK, pharmacist independent prescribers can prescribe for any condition within their clinical competence including systemic anti-cancer therapy. Competency frameworks have been developed but contain little detail on the patient assessment skills pharmacist independent prescribers require to prescribe systemic anti-cancer therapy with concern in the literature over current training on these skills.
To gain consensus on the patient assessment skills required by pharmacist independent prescribers prescribing systemic anti-cancer therapy for genitourinary cancer (prostate and renal) and lung cancer across National Health Service Scotland.
Two phases were performed to generate patient assessment skill consensus. Initially, the Nominal Group Technique was performed within a local cancer network by discussion and participant ranking within genitourinary and lung cancer multi-disciplinary teams. Where consensus was achieved, patient assessment skills were carried forward to try to achieve national (National Health Service Scotland) consensus using a two-round Delphi questionnaire.
Of the 27 patient assessment skills, consensus was gained for 21 and 23 patient assessment skills in the genitourinary and lung Nominal Group Technique groups, respectively. Within the genitourinary and lung national groups, 13/21 and 18/23 patient assessment skills were agreed as required for a pharmacist independent prescriber to prescribe systemic anti-cancer therapy in genitourinary and lung cancer, respectively. Eight common patient assessment skills were identified as core skills. Reasons for not reaching consensus included pharmacist independent prescriber competence, knowledge, skills and the roles and responsibilities of pharmacist independent prescribers within the multi-disciplinary team.
We identified the core and specific patient assessment skills required to prescribe systemic anti-cancer therapy within two tumour groups. Further work is necessary to develop patient assessment skill competency frameworks, training and assessment methods and to redefine the roles of pharmacist independent prescribers within the multi-disciplinary team.
在英国，药剂师独立处方医师能够在其临床能力范围内针对任何病症开出处方，包括全身抗癌治疗。虽然已经制定了能力框架，但对于药剂师独立处方医师在开具全身抗癌治疗处方时所需的患者评估技能，框架中涉及较少，且文献中也对当前这些技能的培训表示担忧。
就苏格兰国民医疗服务体系中，为泌尿生殖系统癌症（前列腺癌和肾癌）及肺癌开具全身抗癌治疗处方的药剂师独立处方医师所需的患者评估技能达成共识。
分两个阶段达成患者评估技能共识。首先，在当地癌症网络内，通过泌尿生殖系统和肺癌多学科团队内部的讨论及参与者排序，运用名义群体技术。达成共识后，将患者评估技能纳入两轮德尔菲调查问卷，以尝试达成全国（苏格兰国民医疗服务体系）共识。
在27项患者评估技能中，泌尿生殖系统和肺癌名义群体技术组分别就21项和23项患者评估技能达成了共识。在泌尿生殖系统和肺癌全国小组中，分别有13/21和18/23项患者评估技能被认为是药剂师独立处方医师开具泌尿生殖系统和肺癌全身抗癌治疗处方时所必需的。确定了八项共同的患者评估技能为核心技能。未达成共识的原因包括药剂师独立处方医师的能力、知识、技能以及其在多学科团队中的角色和职责。
我们确定了在两个肿瘤组中开具全身抗癌治疗处方所需的核心和特定患者评估技能。有必要开展进一步工作，以制定患者评估技能能力框架、培训和评估方法，并重新界定药剂师独立处方医师在多学科团队中的角色。
