36 Describing deprescribing – when are we stopping medications in palliative care?. Issue Volume 9: Issue (2019)Supplement 1 (March 2019)

• Record Type: Journal Article
• Authors: Doré, Matthew; Campbell, Trish; Willis, Derek
• Is Part Of: BMJ supportive & palliative care. Volume 9: Issue (2019)Supplement 1
• Page Start: A22
• Page End: A22
• Publication Date: 2019-03
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2019-ASP.59
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Introduction: Deprescribing is the process of withdrawal of medication with the goal of improving patient care. Research currently is within the context of polypharmacy and geriatrics, however despite its ubiquity within palliative care it has not been studied significantly. Anecdotally, deprescribing is performed adhoc and using 'common sense' but there appears no clear data on rational and benefit. Aim: To gather data on current deprescribing practice within palliative care, with the aim to inform our own specialty and others. Methodology: Prospectively palliative in-patient hospice and community patients had medications which were deprescribed recorded and the rational. This gained a timeline of medication stops respective to date of discharge and/or death. Results: Data collected from 13/3/18 to 30/06/18 with 647 medication stops of 197 differing medications. 56%(361) medication stops were due to approaching end-of-life. 15%(93) due to swallowing difficulties, 17%(109) due to 'rationalising' medications. The median number of days of palliative care deprescribing any medication before death is 4, with 1st quartile (25%) being 1 day and quartile 3 (75%) being 9 days before death. Groups identified and measured, included statins (median 5 days), beta-blockers (median 2 days), ACEi (median 5 days), anti-platelets (median 9 days), and Warfarin/NOACS (median 5 days). Conclusion/discussion: By describing deprescribing we outline the short timespan between medication stopping and death for arguably minimal patient benefit at this point of life. The rational for stopping correlates with this postulation, outlining we are stopping the vast majority of medications due to the dying phase rather than preemptively. Arguably, gathering data alone might inform practice but does not in itself bring about change. We suggest therefore that this study should therefore be seen as a positive step into identifying the need for change in current practice, leading to future studies to outline how change is achieved and measured.