Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands
Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
BMJ Support Palliat Care. 2023 Oct;13(e1):e115-e121. doi: 10.1136/bmjspcare-2018-001623. Epub 2018 Nov 15.
Patients with a limited life expectancy use many medications, some of which may be questionable. OBJECTIVES : To identify possible solutions for difficulties concerning medication management and formulate recommendations to improve medication management at the end of life. METHODS : A two-round Delphi study with experts in the field of medication management and end-of-life care (based on ranking in the citation index in Web of Science and relevant publications). We developed a questionnaire with 58 possible solutions for problems regarding medication management at the end of life that were identified in previously performed studies. RESULTS : A total of 42 experts from 13 countries participated. Response rate in the first round was 93%, mean agreement between experts for all solutions was 87 % (range 62%-100%); additional suggestions were given by 51%. The response rate in the second round was 74%. Awareness, education and timely communication about medication management came forward as top priorities for guidelines. In addition, solutions considered crucial by many of the experts were development of a list of inappropriate medications at the end of life and incorporation of recommendations for end-of-life medication management in disease-specific guidelines. CONCLUSIONS : In this international Delphi study, experts reached a high level of consensus on recommendations to improve medication management in end-of-life care. These findings may contribute to the development of clinical practice guidelines for medication management in end-of-life care.
预期寿命有限的患者会使用许多药物，其中一些药物可能存在疑问。目的：确定解决药物管理困难的可能方法，并制定建议以改善生命末期的药物管理。方法：一项涉及药物管理和临终关怀领域专家的两轮 Delphi 研究（基于在 Web of Science 引文索引和相关出版物中的排名）。我们开发了一份包含 58 种可能解决方案的问卷，这些方案是在先前进行的研究中确定的与生命末期药物管理相关的问题。结果：共有来自 13 个国家的 42 名专家参与了研究。第一轮的回复率为 93%，专家对所有解决方案的平均一致性为 87%（范围为 62%-100%）；另外还提出了 51%的建议。第二轮的回复率为 74%。对药物管理的认识、教育和及时沟通被视为指南的首要任务。此外，许多专家认为至关重要的解决方案包括制定生命末期不适当药物清单，并将生命末期药物管理建议纳入特定疾病指南。结论：在这项国际 Delphi 研究中，专家就改善临终关怀药物管理的建议达成了高度共识。这些发现可能有助于制定生命末期药物管理的临床实践指南。
