Perspectives on deprescribing in palliative care

ABSTRACT

Introduction

Pharmacotherapy plays a critical role in the delivery of high-quality palliative care, but the intersection of palliative care and deprescribing has received little attention.

Areas covered

We conducted a scoping review of English language articles using PubMed to identify relevant publications between 1 January 2000 to 31 July 2022 using search terms of deprescribing, palliative care, end of life, and hospice. We summarize current definitions and developments in palliative care and deprescribing from both clinical and research perspectives. We highlight key challenges and outline proposed solutions and needed research.

Expert opinion

The future of deprescribing in palliative care requires the development and adoption of individualized approaches to medication management, including a reconsidered approach to communication about deprescribing. Evidence from high-quality clinical outcomes studies is lacking, and the field needs new approaches to coordination of care delivery. This review article will be of interest to both clinical and research-based pharmacists, physicians, and nurses interested in improving care for patients with serious illness.

KEYWORDS:

• Deprescribing
• palliative care
• goal concordant prescribing
• end of life
• caregivers
• serious illness
• life-limiting illness

Article highlights

• Pharmacotherapy plays a critical role in the delivery of palliative care, and is essential for pain control, symptom management, and optimizing quality of life.

• Deprescribing has no consensus definition and in palliative care is best conceptualized as ‘the systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within the context of an individual patient’s care goals, current level of functioning, life expectancy, values and preferences.’

• The future of deprescribing in palliative care is grounded in adopting individualized approaches to prescribing and will demand:

• a reconsidered approach to patient-centered communication, including messaging and positivist terminology that focuses on providing care centered in the patients’ goals;

• a melded approach to identifying potentially inappropriate medications in palliative care that is based on both explicit and implicit criteria approaches;

• clinical care coordination across the continuum of life-limiting illness that ‘plants seeds’ that prepare patients and family caregivers for deprescribing in palliative care;

• an evidence base that bolsters clinician confidence in the effectiveness and safety of deprescribing; and

• models of care that address constraints of clinician time and reimbursement.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by the NIH (grant numbers: K24AG068300 and R01 AG068450).