Prescribing practices, patterns, and potential harms in patients receiving palliative care: A systematic scoping review

Cadogan, Cathal; Murphy, Melanie A.; Boland, Miriam; Bennett, Kathleen; McLean, Sarah; Hughes, Carmel

doi:10.1016/j.rcsop.2021.100050

Cited by 13 publications

(14 citation statements)

References 104 publications

(239 reference statements)

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“…This study sought to address recognised gaps with previous observational research examining prescribing practices in palliative care settings by using tools (STOPPFrail (V1 and V2), OncPal, PIP-CPC) that have been specifically developed to examine the prevalence of PIP in adults with lifelimiting illness [16]. Several previous studies have examined the appropriateness of prescribing in this cohort using tools, such as Beers criteria [22], which are not intended for patients in hospice or palliative care settings [23,24].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…As life expectancy decreases, the goal of prescribing typically moves from disease prevention and treatment, to controlling symptoms (e.g. pain), and improving an individual's quality of life [16]. This change in the primary focus of care can lead to medications becoming potentially inappropriate as patients transition to the terminal phase of illness whereby the associated risks of the medication may outweigh the benefits.…”

Section: Introductionmentioning

confidence: 99%

“…While the topic of PIP in older adults with cancer is receiving increased attention [17], there are various issues that need to be addressed. A recent scoping review found that only a minority of studies assessed PIP in patients receiving palliative care, and that the prevalence of patients receiving ≥ 1 PIP ranged from 15 to 92% [16]. The review also highlighted that several studies used tools that are not specific to palliative care populations (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…The review also highlighted that several studies used tools that are not specific to palliative care populations (e.g. Beers criteria) [16]. The use of such tools outside of the intended population could result in the misclassification of medications as potentially inappropriate, where the medication may have an important role, such as managing symptoms experienced by patients towards end of life (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…The PIP-CPC criteria (criteria for identifying Potentially Inappropriate Prescribing in older adults with Cancer receiving Palliative Care) were recently developed to identify PIP involving medications for symptomatic relief in older adults with cancer and limited life expectancy [21]. However, to date, the application of these tools to older adults with cancer has been lacking [16].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Potentially inappropriate prescribing in older adults with cancer receiving specialist palliative care: a retrospective observational study

Murphy¹,

Bennett²,

Wright³

et al. 2022

Int J Clin Pharm

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Background Older adults (≥ 65 years) with cancer receiving palliative care often have other health conditions requiring multiple medications. Aim To describe and assess the appropriateness of prescribing for older adults with cancer in the last seven days of life in an inpatient palliative care setting. Method Retrospective observational study of medical records for 180 patients (60.6% male; median age: 74 years; range 65-94 years) over a two-year period. Medication appropriateness was assessed using: STOPPFrail, OncPal deprescribing guideline and criteria for identifying Potentially Inappropriate Prescribing in older adults with Cancer receiving Palliative Care (PIP-CPC). Results 94.5% of patients had at least one other health condition (median 3, IQR 2-5). The median number of medications increased from five (IQR 3-7) seven days before death, to 11 medications on the day of death (IQR 9-15). The prevalence of PIP varied depending on the tool used: STOPPFrail (version 1: 17.2%, version 2: 19.4%), OncPal (12.8%), PIP-CPC (30%). However, the retrospective nature of the study limited the applicability of the tools. Increasing number of medications had a statistically significant effect on risk of PIP across all tools (STOPPFrail (version 1: 1.29 (1.13-1.37), version 2: 1.30 (1.16-1.48)); OncPal 1.13 (1.01-1.27); PIP-CPC 0.70 (0.61-0.82)). Conclusion This study found that the number of medications prescribed to older adults with cancer increased as time to death approached, and the prevalence of PIP varied with the application of different tools. The study also highlights the difficulties of examining PIP in this patient cohort.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%