Medication use during end-of-life care in a palliative care centre

Abstract

Background: In end-of-life care, symptoms of discomfort are mainly managed by drug therapy, the guidelines for which are mainly based on expert opinions. A few papers have inventoried drug prescriptions in palliative care settings, but none has reported the frequency of use in combination with doses and route of administration.

Objective: To describe doses and routes of administration of the most frequently used drugs at admission and at day of death. Setting Palliative care centre in the Netherlands.

Method: In this retrospective cohort study, prescription data of deceased patients were extracted from the electronic medical records.

Main outcome measure: Doses, frequency and route of administration of prescribed drugs

Results: All regular medication prescriptions of 208 patients, 89% of whom had advanced cancer, were reviewed. The three most prescribed drugs were morphine, midazolam and haloperidol, to 21, 11 and 23% of patients at admission, respectively. At the day of death these percentages had increased to 87, 58 and 50%, respectively. Doses of these three drugs at the day of death were statistically significantly higher than at admission. The oral route of administration was used in 89% of patients at admission versus subcutaneous in 94% at the day of death.

Conclusions: Nearing the end of life, patients in this palliative care centre receive discomfort-relieving drugs mainly via the subcutaneous route. However, most of these drugs are unlicensed for this specific application and guidelines are based on low level of evidence. Thus, there is every reason for more clinical research on drug use in palliative care.

Keywords: Drug therapy; Drug utilization; Netherlands; Palliative care; Pharmaceutical preparations; Prescriptions; Terminal care.

Fig. 1

Differences in top-10 individual drugs at admission (dark grey bars) and at day of death (white bars); shown in descending order for the day of death

Fig. 2

Prescriptions of top-3 drugs; morphine (diamond), midazolam (square) and/or haloperidol (triangle), at several time points during admission