Pharmacists and Deprescribing in a Palliative Care Setting

The health care team and managers in health systems are increasingly recognizing the ability of pharmacists to analyze, review, and consult on medications. With newer responsibilities, now spanning from community pharmacies to interprofessional care teams, pharmacists provide medication-related information to improve health care outcomes.

A 2015 study reported 20% of patients in palliative care were on 8 or more medications.¹ With increasing numbers of medications, the need for pharmacists grows to ensure safety.

As pharmacists take on new responsibilities, researchers have been studying the effects of pharmacists on interprofessional care teams. The Journal of Palliative Medicine published a study to quantify the effect of pharmacists in a palliative care setting.² Because patients in this setting are often on many medications, pharmacists recommend deprescribing drugs for best patient transitions of care.

Researchers looked at 45 inpatient consultations by pharmacists in which they made 184 recommendations and the care team successfully implemented 82% of them. Successful recommendations represent those used during hospitalization and included in the discharge report. On average, prescribers discontinued 3.3 medications per patient.

The study noted that statins, anticoagulants, and antiplatelets accounted for 30% of the deprescribed medications. The highest individual recommendation was vitamins and supplements at 20%.

Although pharmacists recommended discontinuing vitamins and supplements in 37 of the 184 recommendations (20%), the care team discontinued them in only 27 patients. Other differences were seen with antiplatelet medications, which were recommended to be discontinued in 19 patients, but the care team only implemented the recommendation in 13 patients.

The care team agreed with most recommendations for antidiabetic medications and antibiotics. Pharmacists recommended discontinuation in 24 patients and the care team implemented the recommendation in 23 patients (96%). For antibiotics, the care team utilized 100% of the recommendations (9 patients).

When deprescribing, pharmacists remove medications with limited benefit, with more potential harm, and/or to reduce medication burden. The palliative care team discharged 69% of patients to hospice, so they removed medications that were no longer expected to benefit the patient.

This plan aligns with patient care goals to increase quality of life by reducing potential symptoms and medication burden. The most discontinued medications (i.e., vitamins/supplements, antidiabetic, and antiplatelet) were not symptom controllers nor providing benefit to the patient.

Investigators mentioned that the study did not have a comparison group without a pharmacist. The study could not conclude the true effects of pharmacist intervention because they are unsure whether these interventions would be made if the care team had no pharmacist.

Future research should include a comparison group and analysis on the barriers to recommendation acceptance.

About the Author

Dylan DeCandia is a 2023 PharmD candidate at the University of Connecticut.

Resources

1. McNeil MJ, Kamal AH, Kutner JS, et al. The burden of polypharmacy in patients near the end of life. J Pain Symptom Manage. 2016;51:178–183.e2.

2. Cook H, Walker KA, Lowry MF. Deprescribing Interventions by Palliative Care Clinical Pharmacists Surrounding Goals of Care Discussions. J Palliat Med. 2022 Jun 14. doi: 10.1089/jpm.2021.0560. Epub ahead of print. PMID: 35704875.