Pharmacists' role in cancer pain management is limited to a "simple supply function", with restricted access to medical records and fear of emotional involvement being the major barriers, a study published in the International Journal of Pharmacy Practice has found.

There was no "clear vision of precisely what the pharmacists' contribution to cancer pain management might be", as lack of access to patient records made it "hard to see" how pharmacy could offer further support, the study, published earlier this month, found.

Pharmacists felt they did not have enough patient information to offer advice and were "treading on eggshells", researchers reported after conducting interviews with 25 community pharmacists across three areas of England about their role in palliative care.

Pharmacists said they were reluctant to offer an MUR to a cancer patient because they felt "unequipped"	More on cancer care Boots trains pharmacists to offer cancer support Pharmacists to play 'vital' role in bowel cancer       awareness Practical Approach: What is causing this lump?
	"[Pharmacists] had no reliable way of knowing when a patient had cancer pain and so were unable to advise them in more detail," said researchers, led by Imogen Savage of the University of London's School of Pharmacy.

"Even when they had some information from the patients and carers, the pharmacies did not have access to hospital information about the patient."

Pharmacists were also concerned about "emotional involvement" and some pharmacists said they did not offer an MUR to a cancer patient or their carer because they felt "unequipped" to deal with a "tearful moment".

"Being uncertain about diagnosis or prognosis could make it difficult to advise... for fear of putting a foot wrong," the researchers added.

And a lack of communication with the local palliative care team left pharmacists feeling "isolated from other care team members", preventing them from advising towards services, they said.

The authors noted that the only communication would tend to arise from a problem with the patient's prescription. And, even then, pharmacists found it "hard to contact" GPs, citing problems such as "hitting the barrier of receptionist".

Problems obtaining stock were also named as an issue, with one pharmacist feeling they had "failed" the patient if they couldn't fill the prescription on time.

And some pharmacists admitted being uncertain about opioid conversions and drop titration, while some felt they were not "best placed" to discuss opioid medicines.

These barriers made it difficult for pharmacists to offer anything beyond a "simple supply function", the study's authors concluded. "There is significant scope for improving access to and interaction with community pharmacists by people with cancer pain and their families," they said.

The findings came after Boots announced it had trained 500 pharmacists to offer "practical and emotional" support to cancer patients as part of its partnership with Macmillan Cancer Support.

Angela Chalmers, a Boots Macmillan information pharmacist, said the role of the pharmacist in palliative care was just about "face-to-face contact and someone listening".

"We have to give them time because it's taken normally a lot of courage to come in and maybe you're the first person they've opened up to about their fears and they want help not just with their medicines, but we can signpost to counselling services, relaxation classes and complementary therapy," she said.