Discontinuation of medications at the end of life: A population study in Belgium, based on linked administrative databases

Paque, Kristel; Schreye, Robrecht De; Elseviers, Monique; Stichele, Robert Vander; Pardon, Koen; Dilles, Tinne; Christiaens, Thierry; Deliëns, Luc; Cohen, Joachim

doi:10.1111/bcp.13874

Cited by 14 publications

(8 citation statements)

References 40 publications

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“…Some reduction in long-term medicines tends to be offset by prescribing of new medicines to control symptoms (such as pain, nausea and agitation) as the end of life approaches. 22,58,59 CONTEXT AND INTRODUCTION NIHR Journals Library www.journalslibrary.nihr.ac.uk…”

Section: Discussionmentioning

confidence: 99%

“…Such 'potentially inappropriate medications' or 'problematic polypharmacy' 56 is common in palliative care. 59,115 Reasons for deprescribing not taking place include the reluctance of prescribers to broach difficult conversations about the significance of patients no longer needing to take medicines that were formerly prescribed to help keep them alive. 116,117 In addition, clinicians may want to avoid the additional workload of monitoring withdrawal or making changes to dosette boxes, as well as having concerns about creating conflict with the professional who originally prescribed the medication.…”

Section: Deprescribingmentioning

confidence: 99%

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Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study

Pollock

Wilson

Caswell

et al. 2021

Health Serv Deliv Res

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Background More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services. Objective To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting. Design A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops. Setting This took place in Nottinghamshire and Leicestershire, UK. Results As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care. Limitations The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned. Conclusions The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life. Future work Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 99%

Section: Deprescribingmentioning

confidence: 99%

Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study

Pollock

Wilson

Caswell

et al. 2021

Health Serv Deliv Res

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“…People with dementia near the end of life in Belgium often live in a nursing home. Studies report a number of barriers to discontinuing medication in this context, including perceived opposition of the patient’s family or the patient him/herself [ 46 , 47 ]. It has been argued that the initiation of some of the medications mentioned might benefit patients in a palliative care context, to treat symptoms [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…Studies report a number of barriers to discontinuing medication in this context, including perceived opposition of the patient’s family or the patient him/herself [ 46 , 47 ]. It has been argued that the initiation of some of the medications mentioned might benefit patients in a palliative care context, to treat symptoms [ 47 ]. This, coupled with a lack of discontinuation, would lead to a rise in medication use.…”

Section: Discussionmentioning

confidence: 99%

Trends in appropriateness of end-of-life care in people with cancer, COPD or with dementia measured with population-level quality indicators

et al. 2023

Self Cite

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Introduction Measuring changes in the appropriateness of end-of-life care provided to patients with advanced illness such as cancer, COPD or dementia can help governments and practitioners improve service delivery and quality of life. However, an assessment of a possible shift in appropriateness of end-of-life care across the population is lacking. Aim Measuring quality indicators with routinely collected population-level data, this study aims to evaluate the appropriateness of end-of-life care for people with cancer, COPD or dementia in Belgium. Design A population-level decedent cohort study, using data from eight population-level databases, including death certificate and health claims data. We measured validated sets of quality indicators for appropriateness of end-of-life care. Setting/Participants All people who died from cancer or COPD or with dementia between 1st January 2010 and 1st January 2016 in Belgium. Results We identified three main trends over time across the three disease groups of increasing use of: family physicians in the last 30 days of life (+21.7% in cancer, +33.7% in COPD and +89.4% in dementia); specialist palliative care in the last 14 days of life (+4.6% in cancer, +36.9% in COPD, +17.8% in dementia); and emergency department in the last 30 days of life (+7.0% in cancer, +4.4% in COPD and +8.2% in dementia). Conclusions Although we found an increase of both specialized palliative care and generalist palliative care use, we also found an increase in potentially inappropriate care, including ED and ICU admissions. To increase the quality of end-of-life care, both timely initiating (generalist and specialist) palliative care and avoiding potentially inappropriate care transitions, treatments and medications need to be quality performance targets.

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“…[2][3][4][5][6][7] Until recently, no criterion-based tools have been available to assist identification of potentially inappropriate prescribing in people with limited life expectancy. However, recent years have seen the development of tools specifically targeted at appropriateness of prescribing for this vulnerable population, including the STOPPFrail criteria, 8,9 and the criteria developed by Morin et al 10 There is a growing evidence-base for STOPPFrail in identifying and reducing potentially inappropriate medications 5,[11][12][13] whereas the identification of potentially inappropriate medications using the criteria developed by Morin et al is more limited. 7 No previous study has compared the use of the STOPPFrail criteria to other prescribing appropriateness tools in older people with life-limiting illness at the end of life in hospice care.…”

Section: Introductionmentioning

confidence: 99%

Prescribing and deprescribing in older people with life-limiting illnesses receiving hospice care at the end of life: A longitudinal, retrospective cohort study

Alwidyan,

McCorry,

Black

et al. 2023

Palliat Med

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Background: Although prescribing and deprescribing practices in older people have been the subject of much research generally, there are limited data in older people at the end of life. This highlights the need for research to determine prescribing and deprescribing patterns, as a first step to facilitate guideline development for medicines optimisation in this vulnerable population. Aims: To examine prescribing and deprescribing patterns in older people at the end of life and to determine the prevalence of potentially inappropriate medication use. Design: A longitudinal, retrospective cohort study where medical records of eligible participants were reviewed, and data extracted. Medication appropriateness was assessed using two sets of consensus-based criteria; the STOPPFrail criteria and criteria developed by Morin et al. Setting/participants: Decedents aged 65 years and older admitted continuously for at least 14 days before death to three inpatient hospice units across Northern Ireland, who died between 1st January and 31st December 2018, and who had a known diagnosis, known cause of death and prescription data. Unexpected/sudden deaths were excluded. Results: Polypharmacy was reported to be continued until death in 96.2% of 106 decedents (mean age of 75.6 years). Most patients received at least one potentially inappropriate medication at the end of life according to the STOPPFrail and the criteria developed by Morin et al. (57.5 and 69.8% respectively). Limited prevalence of proactive deprescribing interventions was observed. Conclusions: In the absence of systematic rationalisation of drug treatments, a substantial proportion of older patients continued to receive potentially inappropriate medication until death.

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Discontinuation of medications at the end of life: A population study in Belgium, based on linked administrative databases

Cited by 14 publications

References 40 publications

Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study

Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study

Trends in appropriateness of end-of-life care in people with cancer, COPD or with dementia measured with population-level quality indicators

Prescribing and deprescribing in older people with life-limiting illnesses receiving hospice care at the end of life: A longitudinal, retrospective cohort study

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