This abstract was presented as a poster presentation at the May 2002 Society of General Internal Medicine. Revised 3/6/03
Aggregate Results of the Hospice Medical Directors Prescribing Patterns Study, 12/02-2/03
PERCEIVED PALLIATIVE BENEFIT OF MEDICATIONS AMONG HOSPICE MEDICAL DIRECTORS IS NOT UNIVERSAL. S.T. BRAY-HALL; J.S. KUTNER; C.T. KASSNER. University of Colorado Denver, Denver, CO.*
BACKGROUND: There are no established guidelines regarding the palliative benefit of medications in the hospice setting. Which medications will be continued during hospice care is often dependent upon the individual physician. The objective of this study is to better understand the reasons why physicians choose to discontinue certain medications when a patient is admitted to a hospice.
METHODS: We conducted a self-administered survey by mail and email of medical directors of hospices participating in the Population-based Palliative Care Research Network (PoPCRN). The respondents were asked background questions about their training, roles, and hospice experience. They were then given a list of 29 medications and asked to identify the most common reason they choose to discontinue each medication, if at all.
RESULTS: Of the 180 hospices surveyed, 91 medical directors responded, representing 26 states and 69 hospices. The most common reason for stopping a medication, across all medications sampled, was that patients or family requested to discontinue it (32%). Consensus regarding benefit was present for only a small number of medications. Levothyroxine, sinemet, and digoxin were felt to have significant benefit, as these were the most common medications that were never stopped (57%, 49%, and 47% respectively). In contrast, 75% of the respondents discontinue HMG CoA reductase inhibitors because there is no perceived palliative benefit. Cost predominated as the primary reason for discontinuing only erythropoetin and colony stimulating factors. Cost was noted to be a reason for discontinuing medication for only 9% of the responses. No consensus exists regarding the approach to the use of ACE inhibitors, aspirin, anticoagulants, multivitamins, inhaled steroids, proton pump inhibitors, or amiodarone for atrial fibrillation in the hospice setting.
CONCLUSION: This study demonstrates that hospice medical directors clearly believe that some medications belong in the palliative therapeutic arsenal and others have no perceived palliative benefit. With uncertainty in benefit, patient-focused care is the deciding factor. This information may serve as a point of reference for individual practice and to improve care of dying patients and identifies key areas where a better understanding of the role of particular types of medications in the palliative setting is needed.