Futile Drugs in Hospice Patients
Managing medications in hospice patients can be a difficult task, but it is important to stay focused on providing the highest level of comfort for our patients. Many medications used to treat chronic illnesses may no longer be beneficial towards the end of life. In some cases, they may be harmful. As healthcare professionals, we need to identify the goals of the patient, benefit vs. risk of ongoing therapy, and time to benefit from certain medications. Although it may not be appropriate in every situation, reducing or discontinuing the following medications or treatments should be considered:
- Statins for primary prophylaxis of cerebrovascular accident (CVA) or myocardial infarction (MI)
- Dementia medications (donepezil, memantine, galantamine, rivastigmine)
- Vitamins, minerals, supplements
- Bisphosphonates (alendronate, risedronate, zoledronic acid, ibandronate)
- Anticoagulants/anti-platelet agents in certain cases
- Reducing the number of blood pressure medications (lower BP goals may not be necessary)
- Reducing frequency of insulin in type 2 diabetes (tight glycemic control may not be necessary)
- Minimizing fingersticks
- Reducing the frequency of weights
- Labs
When discussing the discontinuation of medications, it is also necessary to be mindful of the barriers we are faced with. Patients, families, and clinicians all have their reasons for denying medication changes. Such as:
- Psychological or physical dependence
- Family feels that they are giving up
- Clinicians may not want to discontinue a medication prescribed by someone else
- Clinicians may feel that discontinuing a medication may worsen the relationship
The beliefs of each patient and family may vary greatly, but proper communication should remain constant. A planned approach combined with effective communication can help alleviate many concerns. As a result, it can help reduce pill burden, minimize adverse reactions, reduce cost, and improve comfort and support for patients when they need it most.
This article was originally published in our monthly issue of From the Front Lines – a monthly publication that shares best practices and medication-related challenges faced by “front line” staff in long-term care and post-acute (LTCPAC) facilities.
