A retrospective observation of corticosteroid use at the end of life in a hospice

Abstract

This study aimed to clarify corticosteroid prescribing during final hospice care, realizing the clinical and ethical dilemmas that may be associated with this therapy. A retrospective review was performed of deaths occurring at our unit during a 6-month period. Corticosteroid use was recorded from drug charts and cross-referenced by case note review. Fifty-one percent of 178 patients received corticosteroids, which were continued until death in 53%. Only 2% were switched from oral to parenteral corticosteroids. The reason for using corticosteroids was documented in 67% of patients. The main indications included treatment for raised intracranial pressure and to give a "boost." The foremost reason for withdrawing corticosteroids was loss of the oral route. These data confirm the high prevalence of corticosteroid use in the terminal phase, even until death. This contrasted with the near absolute withdrawal of corticosteroids once the oral route was lost. The study suggests a need for greater vigilance in corticosteroid prescribing, and identified issues to be addressed in the prescribing of these drugs.