Adjustment of pharmacotherapy during the final days of life in home hospice care: a pilot retrospective study.

Abstract

Background: Effective end-of-life care requires transitioning pharmacotherapy from chronic disease management to symptom relief. Patients in pre-terminal and terminal palliative care may be at risk of receiving potentially inappropriate drugs regarding indication, dosage, route of administration, and polypharmacy, which can increase the risk of deteriorating quality of life. However, data on this process in Home Hospice Care (HHC) is limited. This pilot retrospective study evaluated the pharmacotherapy of 50 patients during their final days under HHC, focusing on changes in treatment and preferred administration routes to optimize symptomatic care.

Methods: Anonymised medical records data were analysed retrospectively to assess the shift from chronic disease pharmacotherapy to symptom and quality-of-life-focused treatment. Statistical methods were applied to identify trends in drug utilisation and administration routes.

Results: The study group qualified the most common drugs associated with potential drug-related problems: antidepressants (26%), sedatives/hypnotics (32%), gastroprotection (34%), antihypertensives (46%), coanalgesics (50%), and analgesics (84%). On the final day, the mean was 2.64 systemic medication (standard deviation 1.27), with a minimum number of drugs and a maximum of 6. The most common symptom addressed was pain, which occurred in 28 patients in the group (56%). Therefore, terminal analgosedation was mapped in more detail when, at the end of life, 26 patients (52%) were terminally transferred to continuous medication administered subcutaneously. Continuous subcutaneous linear driver for analgosedation containing two components was used in 12 patients (46.2%) or three components in 14 patients (53.8%).

Conclusions: This retrospective study highlights the importance of targeted pharmacotherapy adjustments in terminal care, including multidisciplinary HHC teams. Pharmacotherapy is simplified and targeted to prevalent symptoms, using the widely used subcutaneous drug administration.