In patients with a life expectancy of less than one year, the use of preventive medication, such as statins, bisphosphonates, calcium and vitamins, is not useful. Discontinuation of this medication should be considered because the original indication is no longer present or the action of the drug exceeds life expectancy. Use of this medication no longer outweighs possible side effects and the burden of intake. Maintaining such risks and inconveniences is not in line with the value and request-oriented care as described in the Quality Framework Palliative Care (2017 IKNL).
To reduce the amount of unnecessary drugs at the end of life, we will investigate a strategy that focuses on (1) raising awareness of how to stop ineffective medication, (2) education about medications that can be safely stopped and (3) education about having a conversation with a patient whose life expectancy is limited.
The Nurse Practioner will have an Advance Care Planning discussion with the patient about the limited life expectancy and the role of medication use in relation to quality of life. A medication plan will eventually be drawn up in consultation with the patient, general practitioner and pharmacist. After a training for all GPs, pharmacists and nursing practitioners involved, we will use the permanent consultation structure of the palliative consultation team to roll out and evaluate the strategy.
“The greatest gains will be made in quality of life, by reducing side effects and the associated limitations.”
Start intervention: November 2020
End: spring 2022
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