Supporting palliative and end-of-life care in Welsh community pharmacies: a pilot study

The demand for palliative and end-of-life care in Wales is projected to almost double by 2040, increasing from 25% to 47%^​1​. This underscores the increasing importance of community pharmacies in supporting patients with life-limiting illnesses. Palliative and end-of-life care is vital because it prioritises improving quality of life by managing pain, providing emotional support, respecting patient wishes and facilitating end-of-life decision-making. It also supports families during caregiving and bereavement, promoting a holistic approach centred on comfort, dignity and peace. 

In response to this growing need, the Royal Pharmaceutical Society (RPS) and Marie Curie UK introduced the Daffodil Quality Improvement Standards for Community Pharmacy in 2023^​2​. These standards are aimed to enhance the capacity of community pharmacies to deliver effective palliative and end-of-life care by focusing on eight key areas:

1. Professional and competent staff;

2. Early identification;

3. Carer support — before and after death;

4. Seamless, planned and coordinated care;

5. Assessment of the unique needs of the patient;

6. Quality care during the final days of life;

7. Care after death;

8. General practice as hubs within compassionate communities.

As pharmacy workloads and patient interactions are expected to rise, successfully implementing these standards will be critical to ensuring that community pharmacies meet the increasing demand for palliative and end-of-life care services^​3,4​.

In May 2024, a pilot study evaluated the readiness of pharmacy professionals in Wales to manage palliative and end-of-life care patients and implement the Daffodil Standards effectively. The study authors sought to survey Welsh community pharmacies (n=711) to identify the challenges faced by pharmacy professionals; however, owing to constraints, such as the limited project timeline, the response rate was low, with only 24 respondents. The findings from these 24 responses were as follows: 

• Challenges: 79% of respondents (n=19) reported encountering challenges in delivering palliative and end-of-life care, with the most common issue being a busy working environment. Qualitative feedback also highlighted problems, such as stock availability and prescription errors, which further complicated care delivery;
• Training gaps: 54% of respondents (n=13) revealed they had no prior training in palliative and end-of-life care, highlighting a significant gap in preparedness;
• Proposed solutions: 79% of respondents (n=19) identified the need for enhanced educational training, positively emphasising the resources from Marie Curie and RPS^​2​.

The results highlight the urgent need for targeted training programmes and increased support to help community pharmacies meet the rising demand for palliative and end-of-life care.

The study was constrained by time limitations, conducted over one month for a dissertation, which restricted both the depth and duration of data collection. Additionally, the low response rate and the decision to keep survey questions concise to encourage participation may have affected the representativeness of the sample population and depth of the findings, particularly in terms of qualitative feedback.

The results have been shared with Marie Curie and the RPS to highlight the need for targeted training on palliative and end-of-life care within community pharmacies. The study also provided contact information for the Daffodil Standards lead, ensuring community pharmacies are aware of the current training and resources available.

Insights from the study, including identified challenges and proposed solutions, will inform ongoing discussions between Marie Curie and the RPS on how to address key issues, such as stock availability and prescription errors, and guide the effective implementation of the Daffodil Standards.

Building on these findings, a comprehensive study is currently underway across Wales, with plans to extend the survey to the rest of the UK in September 2025, which is aimed to offer a deeper understanding of the challenges community pharmacies face in supporting the education, implementation and awareness of the Daffodil Standards as a nationwide quality improvement initiative. The additional data collected will help identify strategies to address these challenges and will further support the broader collaboration between Marie Curie and the RPS, ultimately enhancing palliative and end-of-life care delivery and ensuring that all patients receive compassionate, high-quality care within their communities.

Chloe Cope, Year 4 MPharm student, Swansea University;

Darrell Baker, the RPS project manager for the Daffodil Standards;

Melanie Healy, senior lecturer and deputy programme director, Swansea University.