Center of Expertise in Palliative Care Utrecht, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands.
Academic Hospice Demeter, De Bilt, The Netherlands.
Palliat Med. 2024 Sep;38(8):884-892. doi: 10.1177/02692163241261202. Epub 2024 Jun 25.
For people with limited lifetime expectancy, the benefit of many medications may be outweighed by their potential harms. Despite the relevance of reducing unnecessary medication use, deprescribing is poorly enacted in primary care practice.
This study aims to describe factors, as identified by primary care professionals and patients, that influence deprescribing in the last phase of life.
Semi-structured interviews were conducted and analysed using a thematic approach.
SETTING/PARTICIPANTS: This study was performed in primary care settings, including general practices, hospices and community care teams in The Netherlands. Purposefully identified primary care professionals (general practitioners, pharmacists, nurses) and patients with limited lifetime expectancy due to advanced chronic illness or cancer and their caretakers were interviewed.
Three themes emerged detailing factors influencing deprescribing in the last phase of life in primary care: (1) non-maleficence, the wish to avoid additional psychological or physical distress; (2) reactive care, the lack of priority and awareness of eligible patients; and (3) discontinuity of care within primary care and between primary care and specialty care.
Deprescribing is an incremental process, complicated by the unpredictability of life expectancy and attitudes of patients and health care professionals that associate continued medication use with clinical stability. Opportunities to facilitate the deprescribing process and its acceptance include the routinely systematic identification of patients with limited life expectancy and potentially inappropriate medications, and normalisation of deprescribing as component of regular primary care, occurring for all patients and continuing into end-of-life care.
对于预期寿命有限的人来说，许多药物的益处可能超过其潜在危害。尽管减少不必要的药物使用具有相关性，但在初级保健实践中，停药的实施情况很差。
本研究旨在描述初级保健专业人员和患者确定的影响生命末期停药的因素。
采用主题分析方法对半结构化访谈进行了分析。
设置/参与者：本研究在初级保健环境中进行，包括荷兰的一般实践、临终关怀和社区护理团队。目的是确定预期寿命有限的初级保健专业人员（全科医生、药剂师、护士）和患有晚期慢性疾病或癌症的患者及其护理人员进行了访谈。
出现了三个主题，详细说明了影响初级保健中生命末期停药的因素：（1）不伤害，避免额外的心理或身体痛苦的愿望；（2）反应性护理，缺乏对合格患者的优先考虑和意识；（3）初级保健内以及初级保健与专科保健之间的护理连续性中断。
停药是一个渐进的过程，由于预期寿命的不可预测性以及患者和医疗保健专业人员的态度，将继续使用药物与临床稳定联系起来，使这一过程变得复杂。促进停药过程及其接受的机会包括系统地确定预期寿命有限和潜在不适当药物的患者，以及将停药规范化为常规初级保健的一部分，适用于所有患者并持续到临终关怀。
