Deprescribing in Hospice and Palliative Care: A Rapid Review of Clinical Tools, Nursing Practice Considerations, and Nursing Policy Implications.

Abstract

Adults with serious illnesses and limited life expectancy often continue medications with little meaningful benefit, contributing to polypharmacy, adverse drug events, patient distress, and caregiver burden. In hospice and palliative care, deprescribing is a systematic, patient-centered process used when medication-related harms outweigh potential benefits. This rapid review examined contemporary evidence on deprescribing practices for adults with serious illnesses, with emphasis on medication burden, deprescribing patterns, current tools and frameworks, and the nursing role in leading, coordinating, and communicating deprescribing decisions in hospice and palliative care. Systematic searches of PubMed, CINAHL, and Scopus were conducted for studies published from January 2020 through December 2025. Of 494 records identified, 37 studies met the inclusion criteria, including qualitative and observational studies, pharmacist-led interventions, systematic reviews, and evaluations of frameworks such as STOPPFrail and OncPal. Evidence indicates that long-term preventive medications near the end-of-life, including statins, antihypertensives, hypoglycemics, antithrombotic agents, and vitamins, often provide limited short-term benefit while increasing the risk of side effects and treatment burden. Despite this, deprescribing remains inconsistent and frequently reactive rather than proactive. Nurses play a central role in medication reconciliation, identifying potentially inappropriate medications, facilitating shared decision-making, and monitoring patient response after medication withdrawal. Deprescribing is an essential component of high-quality hospice and palliative nursing care. When implemented through structured, patient-centered, nurse-led approaches, deprescribing can reduce harm, align treatment with patient goals, and improve comfort and quality of life. Additional research is needed to strengthen communication strategies, operational models, and nursing education related to deprescribing.