Prescription trends at the end of life in a palliative care unit: observational study

Abstract

Background Symptomatic control is essential in palliative care, particularly in end-of-life, in which the pathophysiological changes that characterize this last phase of life strengthen the need to carry out an early therapeutic review. Hence, we aim to evaluate the prescribing pattern at a palliative care unit at two different time points: on admission and the day of the patient’s death. Methods Quantitative, analytic, longitudinal, retrospective and observational study. Participants were adult patients who were admitted and died in a palliative care unit, in Portugal. Sociodemographic, clinical and pharmacological data were collected, including frequencies and routes of administration of schedule prescribed drugs and rescue drugs, from the day of admission until the day of death. Results 115 patients were included with an average age of 70.0 ± 12.9 years old, 53.9 were male, mostly referred by the Hospital Palliative Care Support Teams. The most common pathology was cancer, mainly in advanced stage. On admission, the median scheduled prescription was seven and “as needed” was three drugs. On the day of death, a decrease of prescriptions was observed. Opioids were always the most prescribed drugs. Near death, there was a higher tendency to prescribe butylscopolamine, midazolam, diazepam and levomepromazine. The most frequent route of drug administration was oral on admission and subcutaneous on the day of death. Conclusions Polypharmacy is a reality in palliative care despite specialist palliative care teams. A reduction of prescribed drugs was verified, essentially due less comorbidity-oriented drugs. Further studies are required to analyse the importance of Hospital Palliative Care Support Teams.

Prescription Trends in Hospice Care: A Longitudinal Retrospective and Descriptive Medication Analysis

“…Nevertheless, characteristics of the medication regimens and aspects of medication safety identified here are consistent with those revealed in other studies. 2,7,8,20,21 Both the complexity of patients' drug regimens observed at admission and the progression of their medication therapies support the general assumption in palliative care that regular medications decrease steadily towards death, while the need for PRN medications increases.…”

“…This finding is in accordance with the preference of alternative routes of administration in hospice care. 21,37,38 Subcutaneous drug administration offers a minimal invasive alternative when oral intake of drugs is severely limited. 39,40 This complies with the comfort-oriented approach of hospice care.…”

“…Other studies have previously discussed this issue. 16,18,21 Complex and frequently changing drug therapy regimens, as identified in the medication analysis, require thorough and regular assessment (e.g., medication review) and interprofessional exchange. 28,35,36 A high rate of off-label prescriptions was identified.…”

“…19 The problem of complex drug regimens in palliative care has been investigated and described in several studies. 2,7,20,21 However, studies investigating whether drug regimens in hospice care are associated with similar levels of complexity remain low in number. Most of the available studies only assess medication cross-sectionally at one timepoint only, usually on the day of death.…”

Medizinische und therapeutische Aspekte der Sterbebegleitung

“…Als Faustregel gilt: In der Sterbephase sollen alle Medikamente abgesetzt werden, die für den Patienten keinen Nutzen mehr haben oder prophylaktisch wirken (▶ Tab. 4) [12].…”