Abstract
BackgroundPatients in the last phase of their lives often use many medications. Physicians tend to lack awareness that reviewing the usefulness of medication at the end of patients’ lives is important. The aim of this study is to gain insight into the perspectives of patients, informal caregivers, nurses and physicians on the role of nurses in medication management at the end of life.MethodsSemi-structured interviews were conducted with patients in the last phase of their lives, in hospitals, hospices and at home; and with their informal caregivers, nurses and physicians. Data were qualitatively analyzed using the constant comparative method.ResultsSeventy-six interviews were conducted, with 17 patients, 12 informal caregivers, 15 nurses, 20 (trainee) medical specialists and 12 family physicians. Participants agreed that the role of the nurse in medication management includes: 1) informing, 2) supporting, 3) representing and 4) involving the patient, their informal caregivers and physicians in medication management. Nurses have a particular role in continuity of care and proximity to the patient. They are expected to contribute to a multidimensional assessment and approach, which is important for promoting patients’ interest in medication management at the end of life.ConclusionsWe found that nurses can and should play an important role in medication management at the end of life by informing, supporting, representing and involving all relevant parties. Physicians should appreciate nurses’ input to optimize medication management in patients at the end of life. Health care professionals should recognize the role the nurses can have in promoting patients’ interest in medication management at the end of life. Nurses should be reinforced by education and training to take up this role.
Highlights
Patients in the last phase of their lives often use many medications
Inappropriate medications (PIMs) are medications that should be reconsidered because they have a significant risk of adverse events, for which there is evidence for an or more effective but lower-risk alternative therapy, medications that are prescribed at a higher frequency or for a longer period than clinically indicated, or medications with recognized drug–drug or drug–disease interactions [5]
Medication management in patients with a limited life expectancy involves a complex interplay among patient, informal caregiver, physician and nurse involved
Summary
Patients in the last phase of their lives often use many medications. Physicians tend to lack awareness that reviewing the usefulness of medication at the end of patients’ lives is important. Inappropriate medications (PIMs) are medications that should be reconsidered because they have a significant risk of adverse events, for which there is evidence for an or more effective but lower-risk alternative therapy, medications that are prescribed at a higher frequency or for a longer period than clinically indicated, or medications with recognized drug–drug or drug–disease interactions [5]. This applies to medications prescribed for the treatment of comorbidities or long-term prevention [6,7,8,9]. Many PIMs are continued until the very end of life [10, 11]
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