Deprescribing in end-of-life care

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.