Changes in Prescribed Drugs Between Admission and the End of Life in Patients Admitted to Palliative Care Facilities.

BACKGROUND: The aim of prescribing medication in palliative end-of-life care should be symptom control. Data are lacking regarding the prescription of medication at the end of life. AIM: To investigate the prescription of medication in patients at the end of life in palliative care facilities. DESIGN, SETTING, AND PARTICIPANTS: An observational multicenter study in 7 inpatient palliative care facilities. Participants were adults with an estimated life expectancy of less than 3 months. The study was conducted from February 1, 2012, to January 1, 2013. RESULTS: A total of 155 patients were enrolled. On average, patients were prescribed 6.1 drugs at the moment of admission and 4.6 drugs on the day of death. The prescription of analgesics, psycholeptics, and drugs for functional gastrointestinal disorders increased from admission until death. In general, these are drug classes prescribed for symptom control. All other drug classes decreased between admission and the day of death, including different drug classes for the treatment of comorbid disease, such as anticoagulants, beta-blocking agents, drugs used in diabetes, and lipid-modifying agents. CONCLUSIONS AND RELEVANCE: A reduction in the total amount of medication is seen between admission and death in the palliative care facilities. Although there is an increase in prescribed symptom-specific medication and a reduction in medication prescribed for comorbid disease, there are still patients dying with medication not used for symptom control. This increases pill burden and indicates that physicians need to develop guidelines and educational programs for decreasing medication for comorbidities at the end of life.

Decision making about change of medication for comorbid disease at the end of life: an integrative review.

The main goal of palliative care is to improve quality of life by treating symptoms in patients with life-threatening illnesses. Most patients suffer from more than five severe comorbidities in the last 6 months of life. However, for patients receiving palliative care, interventions to prevent possible long-term complications of these comorbidities are no longer the primary aim of care. This paper aimed to review the literature regarding decision making about medication for comorbid disease at the end of life, defined as a life expectancy <3 months, and to formulate preliminary recommendations based on the existing literature. An integrative review approach was used. We searched the MEDLINE, EMBASE, and CINAHL databases. Papers were included if they had been published in the English language between 1 January 1995 and 31 December 2013, with an abstract. Additional studies were identified by searching bibliographies. Factors to consider when systematically reviewing medications are the goals of care, remaining life expectancy, treatment targets, time until benefit, number needed to treat, number needed to harm, and adverse drug reactions. Existing research focuses particularly on the use of certain drug classes during end-of-life care, including statins, antihypertensive agents, anticoagulants, antihyperglycaemic agents and antibiotics. Based on the results of this review, we made preliminary recommendations for these medication groups. Medication that does not benefit the patient in any way should be avoided. The aim of medication at the end of life should be symptom control. There is a need for prospective trials to give further insight into the decision-making process of medication management at the end of life.