In the realm of palliative care, where the focus is on improving quality of life for patients with serious illnesses, deprescribing has emerged as a crucial component.

Deprescribing refers to the systematic process of reducing or stopping medications that may be unnecessary or potentially harmful, particularly as patients near the end of life. As general practitioners (GPs), understanding and implementing deprescribing practices can significantly enhance the care we provide to our palliative care patients.  

In this blog, we’ll explore the rationale behind deprescribing in palliative care, practical approaches, and the benefits it offers to patients and their families. 

Rationale for Deprescribing in Palliative Care 

The goals of palliative care are centred around improving symptom management, enhancing quality of life, and supporting patients and their families through the end-of-life journey. However, the burden of polypharmacy, or the use of multiple medications, can often outweigh the benefits in this context. Many patients may be taking medications that were initiated for preventive or curative purposes but are no longer appropriate or necessary in the palliative care phase. 

Deprescribing aims to align medication regimens with patients’ goals and preferences, focusing on optimising symptom control while minimising adverse effects and treatment burden. By reassessing the necessity, appropriateness, and potential harms of medications, GPs can tailor treatment plans to better meet the evolving needs of palliative care patients. 

Practical Approaches to Deprescribing 

  1. Conduct a comprehensive Medication Review: Begin by conducting a thorough review of the patient’s medication list, including prescription drugs, over-the-counter medications, and supplements. Evaluate each medication in the context of the patient’s current condition, goals of care, symptom burden, and prognosis. 
  2. Make shared decisions: Engage patients and their families in open and honest discussions about the benefits and risks of continuing or discontinuing medications. Emphasise the importance of aligning treatment decisions with the patient’s priorities, values, and preferences. 
  3. Prioritise Symptom Management: Focus deprescribing efforts on medications that are unlikely to provide meaningful symptom relief or that may exacerbate existing symptoms. For example, medications with limited efficacy, significant side effects, or complex dosing regimens may be candidates for deprescribing. 
  4. Incorporate a Palliative Care Pharmacist: Incorporating a Palliative Care Pharmacist into end-of-life care, particularly within the context of deprescribing, is crucial for optimising medication management and enhancing the quality of life for patients and working collaboratively with the patient’s GP. Their specialised expertise ensures a nuanced understanding of medication interactions, potential side effects, and individual patient needs, all within the delicate balance of end-of-life care. By collaborating with patients, families, caregivers and GPs alike, the involvement of a Palliative Care Pharmacist offers a comprehensive approach that respects patient autonomy and aligns with their wishes. This collaborative effort not only minimises unnecessary medications but also promotes patient comfort, dignity, and holistic well-being during this sensitive phase of life. 
  5. Consider gradual tapering: When discontinuing medications, especially those with potential withdrawal effects or rebound symptoms, consider a gradual tapering approach to minimise discomfort and adverse effects. Monitor patients closely for any signs of symptom recurrence or deterioration during the deprescribing process. 
  6. Provide ongoing monitoring and reassessment: Deprescribing is an iterative process that requires regular monitoring and reassessment. Continue to evaluate the effectiveness of symptom-management strategies, monitor for any new symptoms or changes in the patient’s condition, and adjust treatment plans accordingly. 

Benefits of Deprescribing in Palliative Care 

There are many benefits to deprescribing in palliative care: 

Improved Quality of Life: By reducing medication burden and minimising adverse effects, deprescribing can enhance the overall quality of life for palliative care patients, allowing them to focus on what matters most to them during their remaining time. 

Enhanced Symptom Control: Streamlining medication regimens can improve the effectiveness of symptom management strategies, leading to better control of pain, nausea, dyspnea, and other distressing symptoms commonly experienced in palliative care. 

Reduced Treatment Burden: Simplifying medication regimens through deprescribing can alleviate the physical, emotional, and financial burden associated with polypharmacy, promoting greater comfort and well-being for patients and their families. 

Increased Autonomy and Dignity: Empowering patients to participate in deprescribing decisions fosters a sense of autonomy and dignity, enabling them to exert greater control over their end-of-life care and treatment preferences. 

Deprescribing is not about giving up on patients or withholding necessary care but rather about optimising treatment approaches to align with the goals of palliative care. GPs play a vital role in facilitating deprescribing discussions, advocating for patient-centred care, and promoting the well-being of our palliative care patients. By embracing deprescribing principles and integrating them into our clinical practice, we can ensure that patients receive the most appropriate and compassionate care as they approach the end of life. 

Related Learning 

Palliative Medication Proficiency: Mastering Syringe Drivers and Opioid Administration in Home Settings 

End of Life Care