Deprescribing for patients nearing end of life: views, barriers and facilitators of palliative care patients, carers and nurses.

BACKGROUND

The deprescribing process, which aims to reduce or stop unnecessary medications, remains an area with limited research, especially in patients nearing end of life. Therefore, we aimed to explore the views, barriers and facilitators of patients, their carers and community palliative care nurses about deprescribing for patients nearing end of life.

METHODS

This qualitative study was conducted in Hospis Malaysia, Kuala Lumpur, between September 2021 and August 2022. We recruited patients on ≥ 5 medications, their carers who were ≥ 18 years, and community palliative care nurses from Hospis Malaysia. Nurses were recruited because they conducted home visits, could identify patients who may benefit from deprescribing, and could initiate deprescribing following consultation with physicians. Individual in-depth interviews were conducted using a topic guide. Thematic analysis was used to analyse the transcribed interviews.

RESULTS

Five patients, 9 carers and 11 community palliative care nurses participated. Three themes emerged: (1) use of medications at end of life (2) social influences affecting deprescribing and (3) factors influencing deprescribing. Deprescribing was regarded as essential. Deprescribing was favoured when medication risks outweighed benefits, when medication was financially unsustainable, when swallowing difficulties arose, or when simplifying medication regimens was desired. Conversely, fears of medical relapse and perceived loss of hope acted as barriers. Nurses demonstrated a strong understanding of deprescribing and could implement deprescribing due to robust organisational support. Their confidence was bolstered by consistent guidance from hospice physicians and timely information from pharmacy teams.

CONCLUSION

Deprescribing was deemed essential for patients nearing end of life by patients, carers, and community palliative care nurses. Future research should broaden its scope to encompass diverse healthcare systems and settings, examining how cultural and professional factors influence end-of-life care, thus offering a more comprehensive understanding of deprescribing in various contexts.