title: Implementing oral chemotherapy services in community pharmacies: a qualitative study of chemotherapy nurses' and pharmacists' views.
abstract: OBJECTIVE
  Changes in health-care provision have led to cancer patients being offered oral chemotherapy in the community. Three levels of oral chemotherapy services have been proposed (levels 1, 2 and 3) with community pharmacies playing differing roles within them. This study aims to explore health-care professionals' views on oral chemotherapy services being delivered by community pharmacies and to gain insights into the barriers, facilitators and training/knowledge needs of community pharmacists with respect to providing them.
  
  
  METHODS
  Qualitative semi-structured interviews were conducted with a purposive sample of three chemotherapy nurses, five oncology pharmacists and five community pharmacists. Data were analysed thematically using Framework Analysis.
  
  
  RESULTS
  Findings for level 1 and 2 services included uncertainty on community pharmacists' professional responsibilities, the expertise of GPs in prescribing oral chemotherapy and the training and competency of community pharmacists. The lack of patient information, care and support provision was emphasised for all the models. Although level 1 was achievable in current practice, level 2 was considered the safest option, while level 3 was ideal but risky option. For all levels, training and education for community pharmacists and inter-professional issues were facilitators to oral chemotherapy services. The service environment, dispensing process-related constraints (access to blood test results and protocols) were significant barriers for levels 2 and 3. Advanced communication skills, patient education and counselling were identified as key areas for education and training for community pharmacists.
  
  
  CONCLUSIONS
  The study suggests there are significant concerns and challenges associated with community pharmacies implementing any of the proposed levels of oral chemotherapy services. Educational and training opportunities for community pharmacists and the careful development of safe infrastructures will be essential in the future planning and implementation of any community pharmacy oral chemotherapy service.
authors.affiliation: Pharmacy Department, Kingston University, Kingston upon Thames, UK.
authors.forename: Farida
authors.initials: F
authors.lastname: Butt
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Ream
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001291:Attitude of Health Personnel; D003157:Community Pharmacy Services / Q000458:organization & administration*; D004358:Drug Therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D010595:Pharmacists / Q000523:psychology*; D024382:Professional Role
keywords: anti-cancer; chemotherapy; community; oral; pharmacists