van Nordennen Ronald T C M, Lavrijsen Jan C M, Heesterbeek Malou J A B, Bor Hans, Vissers Kris C P, Koopmans Raymond T C M
Groenhuysen Organisation, Roosendaal, The Netherlands.
Radboud University Medical Centre, Nijmegen, The Netherlands.
J Am Med Dir Assoc. 2016 Jun 1;17(6):514-8. doi: 10.1016/j.jamda.2016.01.015. Epub 2016 Feb 28.
The aim of prescribing medication in palliative end-of-life care should be symptom control. Data are lacking regarding the prescription of medication at the end of life.
To investigate the prescription of medication in patients at the end of life in palliative care facilities.
DESIGN, SETTING, AND PARTICIPANTS: An observational multicenter study in 7 inpatient palliative care facilities. Participants were adults with an estimated life expectancy of less than 3 months. The study was conducted from February 1, 2012, to January 1, 2013.
A total of 155 patients were enrolled. On average, patients were prescribed 6.1 drugs at the moment of admission and 4.6 drugs on the day of death. The prescription of analgesics, psycholeptics, and drugs for functional gastrointestinal disorders increased from admission until death. In general, these are drug classes prescribed for symptom control. All other drug classes decreased between admission and the day of death, including different drug classes for the treatment of comorbid disease, such as anticoagulants, beta-blocking agents, drugs used in diabetes, and lipid-modifying agents.
A reduction in the total amount of medication is seen between admission and death in the palliative care facilities. Although there is an increase in prescribed symptom-specific medication and a reduction in medication prescribed for comorbid disease, there are still patients dying with medication not used for symptom control. This increases pill burden and indicates that physicians need to develop guidelines and educational programs for decreasing medication for comorbidities at the end of life.
在姑息性临终关怀中开具药物的目的应是控制症状。关于临终时药物处方的数据尚缺。
调查姑息治疗机构中临终患者的药物处方情况。
设计、地点和参与者：在7家住院姑息治疗机构进行的一项观察性多中心研究。参与者为预期寿命不足3个月的成年人。研究于2012年2月1日至2013年1月1日进行。
共纳入155例患者。平均而言，患者入院时开具6.1种药物，死亡当天开具4.6种药物。从入院到死亡，镇痛药、抗精神病药和功能性胃肠疾病用药的处方量增加。总体而言，这些都是为控制症状而开具的药物类别。入院到死亡期间，所有其他药物类别均减少，包括用于治疗合并症的不同药物类别，如抗凝剂、β受体阻滞剂、糖尿病用药和调脂药。
在姑息治疗机构中，从入院到死亡期间药物总量有所减少。尽管针对特定症状的处方药物有所增加，用于合并症的处方药物有所减少，但仍有患者临终时使用的药物并非用于控制症状。这增加了药丸负担，表明医生需要制定指南和教育项目，以减少临终时用于合并症的药物。
