Abstract
BackgroundThere is a growing body of evidence suggesting patients with life-limiting illness use medicines inappropriately and unnecessarily. In this context, the perspective of patients, their carers and the healthcare professionals responsible for prescribing and monitoring their medication is important for developing deprescribing strategies. The aim of this study was to explore the lived experience of patients, carers and healthcare professionals in the context of medication use in life-limiting illness.MethodsIn-depth interviews, using a phenomenological approach: methods of transcendental phenomenology were used for the patient and carer interviews, while hermeneutic phenomenology was used for the healthcare professional interviews.ResultsThe study highlighted that medication formed a significant part of a patient’s day-to-day routine; this was also apparent for their carers who took on an active role-as a gatekeeper of care-in managing medication. Patients described the experience of a point in which, in their disease journey, they placed less importance on taking certain medications; healthcare professionals also recognize this and refer it as a ‘transition’. This point appeared to occur when the patient became accepting of their illness and associated life expectancy. There was also willingness by patients, carers and healthcare professionals to review and alter the medication used by patients in the context of life-limiting illness.ConclusionsThere is a need to develop deprescribing strategies for patients with life-limiting illness. Such strategies should seek to establish patient expectations, consider the timing of the discussion about ceasing treatment and encourage the involvement of other stakeholders in the decision-making progress.
Highlights
There is a growing body of evidence suggesting patients with life-limiting illness use medicines inappropriately and unnecessarily
The characteristics for each patient are described in Table 1; for the healthcare professional interviews, three palliative medicine consultants, three advanced nurse practitioners and six general practitioners (GPs) were recruited
The study highlighted that medication formed a significant part of a patient’s day-to-day routine; this was apparent for their carers who took on an active role-as a gatekeeper of care-in managing medication
Summary
There is a growing body of evidence suggesting patients with life-limiting illness use medicines inappropriately and unnecessarily In this context, the perspective of patients, their carers and the healthcare professionals responsible for prescribing and monitoring their medication is important for developing deprescribing strategies. Lindsay and colleagues have taken a different approach and produced a deprescribing guideline suitable for use in palliative cancer patients; [9] this is a defined list of medications (or classes of medication) that could be suitable for stopping in this population (e.g. the use of aspirin for primary prevention of cardiovascular disease) Despite these approaches, patients continue to be prescribed medication unnecessarily and inappropriately-the reasons for which are unclear. This study, aimed to explore the lived experience of patients, carers and healthcare professionals in the context of medication use in life-limiting illness
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