Potentially Inadequate Therapies at the End of Life and their Deprescription by a Palliative Care Team
DOI:
https://doi.org/10.24950/rspmi/O/14/19/2/2019Keywords:
Deprescriptions, Inappropriate Prescribing, Palliative Care, Medical FutilityAbstract
Introduction: People with terminal illnesses are often polymedicated. In the last months of life, some drugs may be considered inadequate. This study intends to evaluate the impact
of the intervention of a palliative care (PC) team on the deprescription of potentially inappropriate drugs (PID).
Methods: Retrospective observational study with adults with
estimated survival of less than 6 months, followed by a PC
team at home, in 2016. The PID were quantified and their deprescription was evaluated, during the first year of follow-up
by the team.
Results: Sixty-eight patients were included, with a mean age
of 77 years. Fifty-seven (83.8%) were medicated with PID.
Functional status did not influence the number of PID. Deprescription occurred in 40% of patients. The number of medical visits was the only variable with a statistically significant
relation with the deprescription (p = 0.004).
Discussion: There was a high prevalence of PID in this sample, regardless of functional status. The data from this study
are in line with the current scientific literature, which suggests
that a significant percentage of patients are medicated with
drugs with no proven benefit at this stage.
Conclusion: It is essential to review the relevance of all end-of-life patients’ medication, due to the high prevalence of PID
and its consequences. Their identification and deprescription
are fundamental actions, whose implementation requires a timely evaluation by CP
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Kutner JS, Blatchford PJ, Taylor DH, Christine S, Bull JH, Fairclough DL, et al. Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness: A Randomized Clinicaln Trial. JAMA Intern Med. 2015;175:691–700. doi: 10.1001/jamainternmed.2015.0289
Riechelmann RP, Krzyzanowska MK. Futile medication use in terminally ill cancer patients. Support Care Cancer. 2009; 17: 745–8. doi: 10.1007/ s00520-008-0541-y
Romero I. “Desprescrever” nos Doentes em Fim de Vida: Um Guia para Melhorar a Prática Clínica. Rev Port Soc Med Interna.2018;25:48–57. doi: 10.24950/rspmi/Revisão/139/1/2018
Lee HR, Yi SY, Kim DY. Evaluation of prescribing medications for terminal cancer patients near death: essential or futile. Cancer Res Treat 2013;45:220–5. doi:10.4143/crt.2013.45.3.220
Currow DC, Stevenson JP, Abernethy AP, Plummer J, Shelby-James TM. Prescribing in palliative care as death approaches. J Am Geriatr Soc. 2007; 55: 590–5.doi: 10.1111/j.1532-5415.2007.01124.x
Coebergh JWW, Post PN. Serious co-morbidity among unselected cancer patients newly diagnosed in the southeastern part of the Netherlands in 1993 – 1996. J Clin Epidemiol. 1999;52:1131–6. doi: 10.1016/S0895- 4356(99)00098-0
Lunney JR, Lynn J, Foley DJ, Lipson S. Patterns of functional decline at the end of life. JAMA. 2015;289:2387–92. doi: 10.1001/jama.289.18.2387
Stevenson J, Abernethy AP, Miller C, Currow DC. Managing comorbidities in patients at the end of life. BMJ. 2004;329: 909–12. doi:10.1136/ bmj.329.7471.909
Holmes HM, Min LC, Yee M, Varadhan R, Basran J, Boyd CM. Rationalizing prescribing for older patients with multimorbidity: considering time to benefit. Drugs Aging. 2014;30:655–66.doi: 10.1007/s40266-013-0095-7
LaRosa JC, He J, Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials.. JAMA. 2015;282:2340-6.. doi:10.1001/jama.282.24.2340
Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK. Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166:2307–13. doi. org/10.1001/archinte.166.21.2307
Akinbolade O, Husband A, Forrest S TA. Deprescribing in advanced illness. Prog Palliat Care. 2016;24:268–71.doi:10.1080/09699260.2016.119 2321
Thompson W, Farrell B. Deprescribing: What Is It and What Does the Evidence Tell Us? Can J Hosp Pharm. 2013;201–2. PMID:23814291
Jansen J, Martin JH. Reducing inappropriate polypharmacy the process of deprescribing. JAMA Intern Med. 2015;175:827–34.doi:10.1001/jamainternmed.2015.0324
Lindsay J, Dooley M, Martin J, Fay M, Kearney A, Barras M. Reducing potentially inappropriate medications in palliative cancer patients: evidence to support deprescribing approaches. Support Care Cancer. 2014; 22: 1113–9. doi: 10.1007/s00520-013-2098-7
Gómez-batiste X, Martínez-muñoz M, Blay C, Amblàs J, Vila L, Costa X, et al. Utility of the NECPAL tool and the Surprise Question as screening tools for early palliative care and to predict mortality in patients with advanced chronic conditions: A cohort study. 2016; 8: 754-63. doi: 10.1177/0269216316676647
Morin L. Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a Eur J Clin Pharmacol. 2018;1333–42. doi: 10.1007/s00228-018-2507-4
Fede A, Miranda M, Antonangelo D, Trevizan L, Schaffhausser H, Hamermesz B, et al. Use of unnecessary medications by patients with advanced cancer: cross-sectional survey. Support Care Cancer. 2011;19: 1313–8. doi: 10.1007/s00520-010-0947-1
Downar J, Goldman R, Pinto R, Englesakis M, Adhikari NK. The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis. CMAJ. 2017;189:484–93. doi:10.1503/cmaj.160775
Domingues D, Carneiro R, Costa I, Monteiro C, Shvetz Y, Barbosa AC. Therapeutic futility in cancer patients at the time of palliative care transition: An analysis with a modified version of the medication appropriateness index. Palliat Med. 2015;29:643–51.doi: 10.1177/0269216315573687
Dewhurst F, Baker L, Andrew I, Todd A, Todd A. Blood pressure evaluation and review of antihypertensive medication in patients with life limiting illness. Int J Clin Pharm. 2016; 38: 2–5. doi: 10.1007/s11096-016-0327-0
Bottorff MB. Statin safety and drug interactions: clinical implications. Am J Cardiol. 2006; 97:27C-31C doi: 10.1016/j.amjcard.2005.12.007
White N, Reid F, Harris A, Harries P, Stone P. A systematic review of predictions of survival in palliative care: how accurate are clinicians and who are the experts? PLoS One. 2016;11: 1–20. doi: 10.1371/journal. pone.0161407
Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J. A systematic review of physicians’ survival predictions in terminally ill cancer patients. BMJ. 2003;327:195-8. doi: 10.1136/bmj.327.7408.195
Nicholson A, Andrew I, Etherington R, Gamlin R, Lovel T, Lloyd J. Futile and inappropriate prescribing: an assessment of the issue in a series of patients admitted to a specialist palliative care unit. Int J Pharm Pract. 2001;9(S1):72. doi: org/10.1111/j.2042-7174.2001.tb01132.x
Choudhuri AH. Palliative care for patients with chronic obstructive pulmonary disease: current perspectives. Indian J Palliat Care. 2012; 18:6-11. doi: 10.4103/0973-1075.97342.
Brown MA, Sampson EL, Jones L, Barron AM. Prognostic indicators of 6-month mortality in elderly people with advanced dementia : A systematic review. Palliat Med. 2012;27: 3–8. doi: 10.1177/0269216312465649
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