Consultation-Based Deprescribing Service to Optimize Palliative Care for Terminal Cancer Patients

Author:

Ko Minoh12ORCID,Kim Sunghwan2,Suh Sung Yun2,Cho Yoon Sook2,Kim In-Wha1,Yoo Shin Hye3,Lee Ju-Yeun1ORCID,Oh Jung Mi1

Affiliation:

1. College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea

2. Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea

3. Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea

Abstract

(1) Background: A pharmacist-led deprescribing service previously developed within the Consultation-Based Palliative Care Team (CB-PCT) was implemented for terminal cancer patients. (2) Objective: To evaluate the clinical outcomes of the developed deprescribing service for terminal cancer patients in CB-PCT. (3) Methods: A retrospective analysis compared the active care (AC) group to the historical usual care (UC) group. The clinical outcomes included the deprescribing rate of preventive medications, the proportion of patients with one or more medication-related problems (MRPs) resolved upon discharge, and the clinical significance. The implementability of the service was also gauged by the acceptance rates of pharmacists’ interventions. (4) Results: Preventive medications included lipid-lowering agents, gastroprotective agents, vitamins, antihypertensives, and antidiabetic agents. The AC group revealed a higher deprescribing rate (10.4% in the UC group vs. 29.6% in the AC group, p < 0.001). At discharge, more AC patients had one or more MRPs deprescribed (39.7% vs. 2.97% in UC, p < 0.001). The clinical significance consistently had a very significant rating (mean score of 2.96 out of 4). Acceptance rates were notably higher in the AC group (30.0% vs. 78.0%. p = 0.003). (5) Conclusions: The collaborative deprescribing service in CB-PCT effectively identified and deprescribed MRPs that are clinically significant and implementable in practice.

Publisher

MDPI AG

Subject

General Medicine

Reference43 articles.

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2. National Hospice Center & Ministry of Health and Welfare (2023, October 29). Hospice & Palliative care in Korea: Facts & Figures 2017, Available online: https://hospice.go.kr:8444/index.html?menuno=22.

3. Hutchison, L., and Sleeper, R. (2015). American Society of Health-System Pharmacists, Fundamentals of Geriatric Pharmacotherapy: An Evidence-Based Approach, American Society of Health-System Pharmacists.

4. Peralta, T., Castel-Branco, M.M., Reis-Pina, P., Figueiredo, I.V., and Dourado, M. (2022). Prescription trends at the end of life in a palliative care unit: Observational study. BMC Palliat. Care, 21.

5. Use of unnecessary medications by patients with advanced cancer: Cross-sectional survey;Fede;Support. Care Cancer,2011

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