Polypharmacy and Deprescribing Patterns in an Australian Palliative Care Unit: A Cohort Study.

CONTEXT: Polypharmacy is prevalent in palliative care and may increase medication burden, adverse drug events, and clinically significant drug-drug interactions as goals of care shift.

OBJECTIVES

To identify factors associated with polypharmacy and describe longitudinal medication use and discontinuation patterns in an Australian metropolitan palliative care unit (PCU).

METHODS

This retrospective cohort study included adults admitted to the PCU in 2023. Medications were assessed at five timepoints: pre-admission (T1), admission (T2), day five (T3), final palliative care phase (P1) and discharge/death (T4). Factors associated with polypharmacy were evaluated using multilevel multivariable logistic regression. Medication discontinuation patterns were categorised with reference to OncPal and Hedman et al criteria.1,2

RESULTS

Among 386 patients, median age was 78 years (IQR 69-87). Polypharmacy was associated with admission for symptom management (aOR 4.07; 95% CI 2.51-6.59) and endocrine comorbidity (aOR 1.73; 95% CI 1.10-2.72), while terminal phase (aOR 0.06; 95% CI 0.03-0.11) and age ≥80 years (aOR 0.34; 95% CI 0.18-0.66) were associated with lower odds. Preventive medications were frequently discontinued. Medications for which tapering is generally recommended, including proton pump inhibitors, beta-blockers, and antidepressants, were often ceased without an observed preceding dose reduction. Symptom-directed medications increased over time.

CONCLUSION

Polypharmacy was more common among younger patients, those admitted for symptom management, and those with endocrine comorbidity. Medication burden changed throughout admission, with preventive therapies frequently discontinued and symptom-directed therapies maintained or increased. These findings highlight opportunities for medication review and deprescribing throughout the palliative care trajectory.