First and SURNAME of the patient:
………
Date of birth of the patient:
...………
INITIAL PHARMACEUTICAL CONSULTATION (Name of the medication). Dose: ……….
Pathology: ………..…….. Treatment to start on: ………
Date: ………..
Pharmacist: ………..
Signature :
Referring doctor: ……….
Duration
Items addressed during the consultation
Memo Objectives
Acquired
Comments
yes no
1 min Making the initial
contact Introduce oneself to the patient
2 min Presentation of the pharmaceutical consultation
We will take 3/4 of an hour to discuss your treatment together.
The aim of this interview is to anticipate the difficulties that you might encounter with your treatment.
.
This consultation is carried out in parallel with
your consultation with a doctor. We are not
substituting for the medical follow-up. Obtain the patient’s consent
10 min Knowledge regarding the patient and their pathology
Please tell me how your treatment has gone to date. Have you encountered any particular difficulties?
Evaluate their knowledge regarding the disease and its implications.
Anticipate problems linked with the therapy.
How well did you tolerate the previous treatments? How were the AI taken care off?
(patient /MT or oncologist/no treatment) You have presumably already heard about chemotherapy? What does it bring to mind? (for patients who have never had chemotherapy) Are you receiving treatment for any other health issues?
How do you feel in general? (e.g. tiredness, pain, problems with digestion, etc.)
10 min Pharmacotherapeutic history
What medications are you taking at home? Do you have injections? Drugs that are inhaled?
Medication patches? Plant-based treatments?
Herbal teas?
Evaluate their knowledge regarding the treatments.
Evaluate their autonomy in regard to the administration.
Anticipate problems linked with the therapeutic.
Your treatment can interact with certain food and plant-derived items. Do you consume any foods in particular? Grapefruit juice for example?
Do you occasionally take any other drugs, if needed? For example in case of pain, fever, or a stomach ache.
Did you encounter any difficulties with these treatments?
How do you prepare your medications at home?
Do you have a pill dispenser? Does someone get the medications ready for you to take? Do you have difficulty swallowing pills and capsules?
Do you have any particular allergies (drugs, food, etc.)?
Duration
Items addressed during the
consultation Memo Objectives Acquired
Comments
yes
noFirst and SURNAME of the patient:
………
Date of birth of the patient:
...………
INITIAL PHARMACEUTICAL CONSULTATION (Name of the medication). Dose: ……….
Pathology: ………..…….. Treatment to start on: ………
Date: ………..
Pharmacist: ………..
Signature :
Referring doctor: ……….
10 min Knowledge regarding the oral anticancer treatment
Please explain to me in your own word what you have gathered from your consultation with the doctor.
Evaluate the patient’s knowledge regarding the treatment that they are starting.
How should it be taken? How many tablets?
Every day? With meals? Have you been told what
to do in case you missed taking your medication?
The treatment is not compatible with certain plant and food items. Do you know which ones?
You have been prescribed other drugs by the
oncologist. How should they be taken?
The oncologist has also told you about adverse effects of the treatment. Would you please explain these to me? How can they be
prevented?
Are you apprehensive to start your treatment? Evaluate their confidence in the treatment
15 min Intervention of the pharmacist
Obtain the contact details of the primary caregivers (i.e. the treating physician, pharmacy, etc.)
If required, restate the administration modalities while taking into account the patient’s habits / other treatments.
Inform If required, restate the main adverse effects
taking into account the patient’s experience in this regard and their knowledge.
If required, restate the measures to take so as to prevent adverse effects.
Ensure that monitoring of the treatment is implemented (a record of laboratory test results, blood pressure, etc)
If required, have other health professionals (oncologist/treating physician/nurse, etc.) perform the pharmaceutical intervention.
5 min Wrapping up of the interview
Do you require additional information regarding your treatment?
We are nearing the end of our interview. Let’s go
over the key information one more time. Evaluate understanding of the main items. Have them restate it.
Provide written document recapitulating the interview (for example a medication sheet)
