Medication management in the last stage of life

Patients in the palliative phase of their illness often use many drugs. It
could include medication that no longer useful or even harmful in the final
stage of life. Medication management in end-of-life care is often difficult
because of the interrelation of medical, emotional and ethical factors.
Knowledge about and guidelines for the adequate management of medication in the
last stages of life are missing. A systematic evaluation of current practices
surrounding medication management for patients in the last phase of life has
not yet occurred.

The purpose of this research is to create a description of the current
practice, and to make recommendations to improve medication management in the
last phase of life. More specifically, the research will focus on the
clarification of substantive medical, practical and ethical aspects of
medication management at the end of life. The research will focus on primary
care, clinical departments for palliative care and hospices. Identifying
bottlenecks and improvement cooperation between these three settings is an
important goal of the research.

First, known medication management models will be studied for their usefulness
as a basis for medication management at the end of life. Second, in a dossier
study, knowledge of the nature and extent of the use of useless or harmful
drugs in the last phase of life be obtained.

Third, substantive medical and ethical considerations about the current
practice of medication management will be clarified in-depth interviews with
caregivers, patients and relatives.

Fourth, the findings from the literature review, the dossier and the interview
studies will be used in a questionnaire study aimed to give a representative
picture of current practice.

Eventually a Delphi procedure among experts will lead to the formulation of
recommendations and tools for practice. The research will culminate in a
medical and ethical framework for medication management in the last phase of
life that meets the needs of those involved in daily practice that in the long
term (beyond the scope of this study) can be developed into a guide line.

It contributes to the optimization of care and quality of life in the last
phase of life and a dignified death phase.

To gain in-depth knowledge of the reasons, preferences and values of patients,
relatives, nurses and physicians about decision-making concerning
continuation, adjusting and medication withdrawal in the last phase of life.

Prospective in-depth interviews with patients with a life expectancy of less
then three months, their closest relative(s), the first responsible nurse and
the attending physician.

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