1 Clinical Pharmacology Research Unit, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.
2 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
Palliat Med. 2019 Jan;33(1):37-48. doi: 10.1177/0269216318801124. Epub 2018 Sep 19.
: Knowing the barriers/enablers to deprescribing in people with a life-limiting disease is crucial for the development of successful deprescribing interventions. These barriers/enablers have been studied, but the available evidence has not been summarized in a systematic review.
: To identify the barriers/enablers to deprescribing of medications in people with a life-limiting disease.
: Systematic review, registered in PROSPERO (CRD42017073693).
: A systematic search of MEDLINE, Embase, Web of Science and CENTRAL was conducted and extended with a hand search. Peer-reviewed, primary studies reporting on barriers/enablers to deprescribing in the context of explicit life-limiting disease were included in this review.
: A total of 1026 references were checked. Five studies met the criteria and were included in this review. Three types of barriers/enablers were found: organizational, professional and patient (family)-related barriers/enablers. The most prominent enablers were organizational support (e.g. for standardized medication review), involvement of multidisciplinary teams in medication review and the perception of the importance of coming to a joint decision regarding deprescribing, which highlighted the need for interdisciplinary collaboration and involving the patient and his family in the decision-making process. The most important barriers were shortages in staff and the perceived difficulty or resistance of the nursing home resident's family - or the resident himself.
: The scarcity of findings in the literature highlights the importance of filling this gap. Further research should focus on deepening the knowledge on these barriers/enablers in order to develop sustainable multifaceted deprescribing interventions in palliative care.
了解限制生命疾病患者药物减停的障碍/促进因素对于成功开展药物减停干预至关重要。这些障碍/促进因素已经过研究，但现有的证据尚未在系统综述中进行总结。
确定限制生命疾病患者药物减停的障碍/促进因素。
系统评价，在 PROSPERO（CRD42017073693）中注册。
系统检索 MEDLINE、Embase、Web of Science 和 CENTRAL，并进行了手工检索。本综述纳入了报告明确限制生命疾病背景下药物减停障碍/促进因素的同行评审、原始研究。
共检查了 1026 篇参考文献。符合标准的 5 项研究被纳入本综述。发现了 3 种类型的障碍/促进因素：组织、专业和患者（家庭）相关的障碍/促进因素。最突出的促进因素包括组织支持（例如，标准化药物审查）、多学科团队参与药物审查以及对共同决策进行药物减停的重要性的认知，这突出了跨学科合作的必要性以及在决策过程中让患者及其家属参与的必要性。最重要的障碍是人员短缺以及养老院患者及其家属或患者自身对护理的困难或抵触情绪。
文献中发现的结果很少，突出了填补这一空白的重要性。进一步的研究应重点深入了解这些障碍/促进因素，以便在姑息治疗中开发可持续的多方面药物减停干预措施。
