Akinbolade O, Husband A, Forrest S, Todd A Deprescribing in advanced illness.. Progress Palliat Care. 2016; 24:(5)268-271

Alldred DP De prescribing: a brave new word?. Int J Pharm Pract. 2014; 22:(1)2-3

Braganza MA, Glossop AJ, Vora VA Treatment withdrawal and end of life care in the intensive care unit.. BJA Educ. 2017; 17:(12)396-400

Dore M, Campbell T, Willis D Describing deprescribing—when are we stopping medications in palliative care?.. BMJ Support Palliat Care. 2019; 9

Ellershaw J, Wilkinson SOxford: Oxford University Press; 2003

Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation.. Int J Clin Pharmacol Ther. 2008; 46:(2)72-83

Goncalves F Deprescription in advanced cancer patients.. Pharmacy. 2018; 6:(3)

Holmes HM, Todd A Evidence-based deprescribing of statins in patients with advanced illness.. JAMA Intern Med. 2015; 175:(5)701-702

Jansen K, Schaufel MA, Ruths S Drug treatment at the end of life: an epidemiologic study in nursing homes.. Scand J Prim Health Care. 2014; 32:(4)187-192

Kutner JS, Blatchform PJ, Talylor DH Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial.. JAMA Intern Med. 2015; 175:(5)691-700

Lavan AH, Gallagher P, Parsons C, O'Mahony D STOPP Frail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation.. Age Ageing. 2017; 46:600-607

Lindsay J, Dooley M, Martin J, Fay M, Kearney A, Barras M Reducing potentially inappropriate medications in palliative cancer patients; evidence to support de prescribing approaches.. Support Care Cancer. 2014; 22:(4)113-119

Mangoni A, Jackson S Age related changes in pharmacokinetics and pharmacoodynamics: basic principles and practical applications.. Br J Clin Pharmacol. 2003; 57:(1)6-14

McNeil M, Kamal A, Kutner J, Richie C, Abernethy A The burden of polypharmacy in patients near the end of life.. J Pain Symptom Manage. 2016; 51:(2)178-183

National Institute for Health and Care Excellence. 2015a.

National Institute for Health and Care Excellence. 2015b.

NHS Digital. 2017.

Penson J, Fisher AOxford: Oxford University Press; 2002

Reeve E, Wiese MD, Hendrix I, Roberts MS, Shakib S People's attitudes, beliefs, and experiences regarding polypharmacy and willingness to deprescribe.. J Am Geriatr Soc. 2013; 61:(9)1508-1514

Reeve E, Thompson W, Farrell B Deprescribing: a narrative review of the evidence and practical recommendations for recognizing opportunities and taking action.. Eur J Intern Med. 2017; 28:(2017)3-11

Scott A, Himer S, Reeve E Reducing inappropriate polypharmacy: the process of deprescribing.. JAMA Intern Med. 2015; 175:(5)827-834

Scott IA, Le Couteur DG Physicians need to take the lead in deprescribing.. Intern Med J. 2015; 45:(3)352-356

Thomas KOxford: Radcliffe Medical Press; 2004

Todd A, Nazar H, Pearson H, Andrew L, Baker L, Husband A Inappropriate prescribing in patients accessing specialist palliative day care services.. Int J Clin Pharm. 2014; 36:(3)535-543

Wessex Palliative Physicians. 2014.

Deprescribing in end-of-life care

02 October 2019
Volume 24 · Issue 10


The aim of deprescribing in end-of-life care is to improve the patient's quality of life by reducing their drug burden. It is essential to engage the patients and enable them to make choices about medications by discussing their preferences and implement a pharmacy management plan. Withdrawing medications during the end stages of life is extremely complex because the period of care varies substantially. The aim of this article is to address polypharmacy within end-of-life care. It will review which medications should be stopped by examining the non-essential and essential drugs. The intention is to encourage an approach to care which provides an equal balance between treatment and patient expectation.

Deprescribing is a process of removing potentially inappropriate or unnecessary medications (Reeve et al, 2017). Non-adherence, lack of efficacy, actual or potential adverse drug reactions, the development of a contraindication, request from a patient and end of life are all reasons for discontinuing drugs (Reeve et al, 2013).

For non-medical prescribers (NMPs), it is important to consider deprescribing within all elements of their practice in an attempt to reduce pill burden and the subsequent ramifications of polypharmacy, with the aim of improving patient outcomes and care. Withdrawing medications during the end stages of life is extremely complex because the period of care varies substantially. Withdrawing too soon may be perceived as negligent and causing potential harm; too late, would result in unnecessary treatment and subjecting the patient to the unnecessary stress of taking the medication (Duerdon et al, 2013). In palliative care, the median number of days of deprescribing any medication was found to be 4 days before death (Dore et al, 2019). The study broke it down further and found that 15% of medications were stopped due to swallowing difficulties, 17% due to rationalising medications and 56% due to approaching end of life. McNeil et al (2016) demonstrated that patients enrolled in their study took an average of 11.5 medications when joining the study and 10.7 at death or study termination.

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