End of life care is a delicate process. Patients who face life-limiting illness must come to grips with the reality of their diagnosis, and so must their physicians. There is a tendency in the medical community to continue curative care for far too long when palliative care and end of life care should be employed instead to give patients better quality of life. One of the steps in the transition from curative care to end of life care is a process called deprescribing. Too often, doctors continue to prescribe unnecessary medications for fear of making their patients feel medically abandoned. A new study released by Oregon State University has shown patients in end of life care may not feel medically abandoned when a doctor begins deprescribing.
What is deprescribing?
Deprescribing is simply defined as ceasing to prescribe certain medications no longer necessary when a patient receives a life-limiting diagnosis. The medications that are generally deprescribed are those that are used in preventative and curative care. For example, a patient taking statins to reduce cholesterol and prevent heart disease may no longer need to take the medication if they are diagnosed with terminal cancer. In such situations, deprescribing eliminates unnecessary medications that once served a purpose, but whose purpose no longer applies in face of a life-limiting illness.
Do patients feel medically abandoned during deprescribing?
Given the lack of information about patient perceptions regarding deprescribing, these data are important and useful as a stepping stone.
A recent study by Oregon State University examined the attitudes of patients nearing the end of life toward deprescribing. The study looked at 300 patients in end of life care across the country who participated in a clinical trial to determine if discontinuing stain therapy was safe. Among the participants, the average age was 72 with a life expectancy of less than 12 months.
“We know these patients are on a lot of medications,” explained study author Jon Furuno. “There’s a lot of concern that patients will feel like doctors are giving up on them if they start to discontinue some of their medications, that there’s something comforting about continuing to take their medications, and this gives us some indication of what patients feel about the risks and benefits of deprescribing.”
Fewer than five percent of study participants reported feeling abandoned by their doctor when deprescribing statins. In fact, many participants reported seeing the benefits of discontinuing statins, including improvements in quality of life, the prospect of discontinuing other medications, and reduced medication costs.
“Hopefully this will help inform prescribers who might be tentative to address this topic with their patients. As a patient’s prognosis changes and we think they have a relatively short lifespan left, it really requires risk/benefit re-examination of everything we’re doing for them, medications and everything else,” explained Furuno.
Furuno noted in the study that it drew all its respondents from a pool of patients who had already agreed to undergo a clinical trial to remove statins. These participants, therefore, may have been more receptive to deprescribing than the general population. Furuno explained, “This group is likely not completely representative of all people, because they might be foreseeing some benefits to stopping that other people hadn’t considered. But while we don’t want to overlook that limitation, given the lack of information about patient perceptions regarding deprescribing, these data are important and useful as a stepping stone.”