The development and evaluation of an oncological palliative care deprescribing guideline: the 'OncPal deprescribing guideline'

Abstract

Purpose: Current data suggests that potentially inappropriate medicines (PIMs) are common in palliative cancer patients; however, there is a lack of criteria to assist clinicians in identifying PIMs in these patients. The aims of this study were to design and validate a deprescribing guideline for palliative cancer patients and to undertake a descriptive analysis of the identified PIMs.

Methods: This prospective, non-interventional cohort study consisted of four major stages: developing an 'OncPal Deprescribing Guideline' from current evidence, the prospective recruitment of consecutive palliative cancer inpatients with an estimated <6-month prognosis, the assessment of all medications to identify PIMs using both a panel of medical experts without access to the guideline as well as a Clinical Pharmacist independently using the OncPal Deprescribing Guideline and the evaluation of the guideline by testing concordance. Descriptive data on the incidence of PIMs identified were also assessed.

Results: A total of 61 patients were recruited. The OncPal Deprescribing Guideline matched 94% of 617 medicines to the expert panel with a Kappa value of 0.83 [95% CI (0.76, 0.89)] demonstrating an 'outstanding' concordance. Forty-three (70%) patients were taking at least one PIM, with 21.4% of the total medicines assessed identified as PIMs. The medication-associated cost per patient/month was AUD$26.71.

Conclusion: A guideline to assist in the de-escalation of inappropriate medications in palliative cancer patients was developed from current literature. The OncPal Deprescribing Guideline was successfully validated, demonstrating statistically significant concordance with an expert panel. We found that the incidence of PIMs was high in our patient group, demonstrating the potential benefits for the OncPal Deprescribing Guideline in clinical practice.