Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
J Am Med Dir Assoc. 2023 Sep;24(9):1297-1302.e1. doi: 10.1016/j.jamda.2023.04.007. Epub 2023 May 22.
Benzodiazepine and antipsychotic medications are common components of the hospice toolkit and are routinely prescribed for behavioral symptom management at end of life. These medications have significant associated risks but, despite their frequent use, little is known about how clinicians weigh prescribing decisions for individuals in hospice. In this qualitative study, we examined the key factors that influence the decision to initiate a benzodiazepine and antipsychotic medication for management of behavioral symptoms at end of life.
A qualitative study using semi-structured interviews and descriptive qualitative analysis.
We conducted semi-structured interviews with prescribing hospice physicians and nurse practitioners working in hospice settings across the United States.
Hospice clinicians were asked to describe factors that influence prescribing decisions to initiate benzodiazepine and antipsychotic medications for the management of behavioral symptoms. Data from audio-recorded sessions were transcribed, coded to identify relevant concepts, and reduced to determine major themes.
We completed 23 interviews with hospice physicians and nurse practitioners. On average, participants had worked in a hospice setting for a mean of 14.3 years (SD: 10.9); 39% had geriatrics training. Major themes related to benzodiazepine and antipsychotic prescribing were (1) caregiving factors strongly influence the use of medications, (2) patient and caregiver stigma and concerns regarding medication use limit prescribing, (3) medications are initiated to avoid hospitalization or transition to a higher level of care, and (4) nursing home hospice care brings unique challenges.
Caregiver factors and the setting of hospice care strongly influence clinician decisions to initiate benzodiazepines and antipsychotics in hospice. Caregiver education about medication use at end of life and support in managing challenging behaviors may help promote optimal prescribing.
苯二氮䓬类药物和抗精神病药物是临终关怀工具包中的常见组成部分，常用于管理生命末期的行为症状。这些药物存在显著的相关风险，但尽管它们经常被使用，对于临床医生在临终关怀中如何权衡个体的处方决策却知之甚少。在这项定性研究中，我们研究了影响启动苯二氮䓬类和抗精神病药物以管理生命末期行为症状的处方决策的关键因素。
使用半结构式访谈和描述性定性分析的定性研究。
我们在美国各地的临终关怀环境中与开具处方的临终关怀医生和执业护士进行了半结构式访谈。
要求临终关怀临床医生描述影响启动苯二氮䓬类和抗精神病药物以管理行为症状的处方决策的因素。从录音会议转录的数据进行编码以识别相关概念，并进行简化以确定主要主题。
我们完成了 23 名临终关怀医生和执业护士的访谈。参与者平均在临终关怀环境中工作了 14.3 年（标准差：10.9）；39%接受过老年医学培训。与苯二氮䓬类和抗精神病药物处方相关的主要主题包括：（1）照护因素强烈影响药物的使用，（2）患者和照护者的耻辱感以及对药物使用的担忧限制了处方，（3）启动药物是为了避免住院或转为更高水平的护理，（4）疗养院临终关怀带来了独特的挑战。
照护者因素和临终关怀环境强烈影响临床医生在临终关怀中启动苯二氮䓬类和抗精神病药物的决策。关于临终时药物使用的照护者教育和管理挑战性行为的支持，可能有助于促进最佳处方。
