生命末期减药的建议：一项国际德尔菲研究。

Recommendations for Deprescribing of Medication in the Last Phase of Life: An International Delphi Study.

作者信息

Elsten Eline E C M, Pot Iris E, Geijteman Eric C T, Hedman Christel, van der Heide Agnes, van der Kuy P Hugo M, Fürst Carl-Johan, Eychmüller Steffen, van Zuylen Lia, van der Rijt Carin C D

机构信息

Department of Medical Oncology (E.E.C.M.E., I.E.P., E.C.T.G., C.C.D.V.D.R.), Erasmus Medical Center, Cancer Institute Rotterdam, Netherlands; Department of Public Health (E.E.C.M.E., A.V.D.H.), Erasmus Medical Center, University Medical Center Rotterdam, Netherlands.

Department of Medical Oncology (E.E.C.M.E., I.E.P., E.C.T.G., C.C.D.V.D.R.), Erasmus Medical Center, Cancer Institute Rotterdam, Netherlands.

出版信息

J Pain Symptom Manage. 2024 Nov;68(5):443-455.e2. doi: 10.1016/j.jpainsymman.2024.07.029. Epub 2024 Aug 2.

DOI:10.1016/j.jpainsymman.2024.07.029

PMID:39094669

Abstract

CONTEXT

Medications may become inappropriate for patients in the last phase of life and may even compromise their quality of life.

OBJECTIVE

To find consensus on recommendations regarding deprescribing of medications for adult patients with a life expectancy of six months or less.

METHODS

Experts working in palliative care or other relevant disciplines were asked to participate in this international Delphi study. Existing tools for deprescribing of medication in the last phase of life were integrated in a list of 42 recommendations regarding potential deprescription of various medication types. In two Delphi rounds, experts were asked to rate their agreement with each recommendation on a 5-point Likert-scale (strongly agree-strongly disagree). Recommendations were accepted, if at least 70% of the experts (strongly) agreed, the interquartile range (IQR) was one or less, and less than 10% strongly disagreed.

RESULTS

About 47 experts from 10 countries participated (response rate 53%). In most cases (76%), consensus was reached on deprescribing recommendations for patients with a life expectancy of six months or less. The highest level of consensus was reached for recommendations on the deprescription of diuretics in case of decreasing fluid intake or increasing fluid loss, lipid modifying agents if prescribed for primary prevention, and vitamin K antagonists and direct oral anticoagulants in case of high bleeding risk.

CONCLUSION

A high level of consensus was reached on recommendations on potential deprescription of several medications for patients with a life expectancy of six months or less.

摘要

背景

在生命的最后阶段，药物治疗可能对患者不再适用，甚至可能损害他们的生活质量。

目的

就预期寿命为六个月或更短的成年患者减停药物治疗的建议达成共识。

方法

邀请从事姑息治疗或其他相关学科的专家参与这项国际德尔菲研究。将现有的生命最后阶段减停药物治疗的工具整合到一份包含42条关于各种药物类型潜在减停建议的清单中。在两轮德尔菲调查中，要求专家们按照5级李克特量表（从强烈同意到强烈不同意）对每条建议的同意程度进行评分。如果至少70%的专家（强烈）同意，四分位间距（IQR）为1或更小，且强烈不同意的专家少于10%，则该建议被接受。

结果

来自10个国家的约47名专家参与了研究（回复率53%）。在大多数情况下（76%），就预期寿命为六个月或更短的患者减停药物治疗的建议达成了共识。对于液体摄入量减少或液体流失增加时利尿剂的减停建议、用于一级预防时的调脂药物、以及出血风险高时的维生素K拮抗剂和直接口服抗凝剂的减停建议，达成的共识程度最高。