‘I don’t think I’d be frightened if the statins went’: a phenomenological qualitative study exploring medicines use in palliative care patients, carers and healthcare professionals.

Abstract

BackgroundThere is a growing body of evidence suggesting patients with life-limiting illness use medicines inappropriately and unnecessarily. In this context, the perspective of patients, their carers and the healthcare professionals responsible for prescribing and monitoring their medication is important for developing deprescribing strategies. The aim of this study was to explore the lived experience of patients, carers and healthcare professionals in the context of medication use in life-limiting illness.MethodsIn-depth interviews, using a phenomenological approach: methods of transcendental phenomenology were used for the patient and carer interviews, while hermeneutic phenomenology was used for the healthcare professional interviews.ResultsThe study highlighted that medication formed a significant part of a patient’s day-to-day routine; this was also apparent for their carers who took on an active role-as a gatekeeper of care-in managing medication. Patients described the experience of a point in which, in their disease journey, they placed less importance on taking certain medications; healthcare professionals also recognize this and refer it as a ‘transition’. This point appeared to occur when the patient became accepting of their illness and associated life expectancy. There was also willingness by patients, carers and healthcare professionals to review and alter the medication used by patients in the context of life-limiting illness.ConclusionsThere is a need to develop deprescribing strategies for patients with life-limiting illness. Such strategies should seek to establish patient expectations, consider the timing of the discussion about ceasing treatment and encourage the involvement of other stakeholders in the decision-making progress.

Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action

“…The beliefs of caregivers towards deprescribing have been found to be similar, however, acting as a surrogate decision maker is difficult and feelings of guilt and responsibility if their care recipient's condition worsens have been reported [57,59]. Todd and colleagues explored the attitudes of palliative care patients towards medication withdrawal [60]. When patients were accepting of their illness and disease trajectory, they reported placing less importance on their medications and they no longer had fear surrounding ceasing them.…”

“…Turner et al identified that a polypharmacy cut point of between 3.5 and 6.5 medications predicted negative outcomes in older adults with cancer [104], while Lindsay and colleagues have developed a list of potentially inappropriate medications in this population to support deprescribing activities [105]. Optimising medication use and withdrawal of non-life sustaining medications is a recognised part of palliative care, however, opportunities for reducing polypharmacy are being missed which has led to a renewed focus on deprescribing in palliative care patients [20,60,106].…”

Deprescribing: a primary care perspective

“…A qualitative study in the USA to explore palliative care patients’, carers’ and healthcare professionals’ views on stopping unnecessary medications, such as statins, found that patients were accepting of the concept of stopping preventative medications once they had come to terms with the fact that their illness was life-limiting 67. The authors concluded that it was important to explore patients’ expectations of their illness and treatment, and to time discussions about stopping medications appropriately.…”

Continuation of non-essential medications in actively dying hospitalised patients

“…Although lipid-lowering agents may play an anti-inflammatory role, the value of lipid-lowering agents is doubtful among patients with minimal food intake. Similarly, we did not observe a statistically significant change in the prevalence of orders for statins, although emerging research provides evidence of willingness among clinicians, family members and patients to discontinue medications such as statins in palliative care settings 30. A recent randomised trial of continuation of statins versus discontinuation of statins demonstrated that there were no negative consequences to discontinuation of statins in the last months of life 31.…”