Pharmacist prescribing in cancer services: a scoping review

Abstract

Background: Pharmacist prescribing (PP) is embedded in clinical practice in various countries, and for a range of clinical conditions. PP occurs in cancer services, but there is limited information describing its extent and impact.

Aim: This scoping review aimed to explore PP in cancer services, prescribing models used, impact on patient outcomes and stakeholders' views.

Method: The Joanna Briggs Institute's scoping review guidelines were followed. The population-concept-context framework guided inclusion (population: patients with cancer; concept: pharmacist prescribing; context: cancer services in any care setting). All research articles were eligible for inclusion. Case reports/series, commentaries, articles not in English, were excluded. Embase, Scopus, Google Scholar, Web of Science and CINAHL were searched using a combination of search terms e.g. 'pharmacist prescribing', 'nonmedical prescribing', 'cancer', 'oncology. Titles, abstracts and full texts were reviewed independently by two researchers, disagreements were resolved by discussion and results were narratively synthesised.

Results: 2453 titles and abstracts were screened, 461 full-texts were reviewed, 41 were included, published between 2008 and 2023. When setting was described, PP was described in tertiary (n = 35), primary (n = 2) and secondary care (n = 1). Various PP models were described, including collaborative prescribing models (PP within protocols agreed with a physician), independent prescribing and supplementary prescribing (PP within a clinical management plan agreed by a physician and patient). All models demonstrated improvement in patient outcomes, adherence, and patient experiences (e.g. reduced time in clinic). Patients and physicians expressed initial reservation, but were largely supportive. Pharmacists reported enhanced job satisfaction. In order to effect change in prescribing practices, regulatory changes, advanced education and training and stakeholder engagement were required.

Conclusion: Collaborative prescribing models are the most commonly described PP models used in cancer services. There is potential for expanding pharmacists' scope of practice in cancer services where this is not routine.

Keywords: Cancer; Collaborative practice agreements; Independent prescribing; Oncology; Supplementary prescribing; pharmacist prescribing.