MEDication management In the LAST phase of life
Patients in the palliative phase of a chronic disease often use multiple medications. With the occurrence of new diseases and symptoms medications are often added without reference to symptom- or disease-specific guidelines; increasing the risk of adverse effects and interactions. As death approaches, the use of these medications may become irrational and sometimes even harmful. Medical, emotional and ethical factors are responsible for difficulties with medication management in the last phase of life. There is currently a lack of knowledge over and guidelines for the appropriate management of medications when death approaches. When and how prescribed medications must be stopped, adjusted or added is the question that motivated our research project. Our aim is to describe the current practice of and to formulate recommendations to improve medication management in the last phase of life.
This research project is carried out in the framework of a grant provided by the Netherlands Organization for Health and Development (ZonMw) with the collaboration between VU University Medical Center, Erasmus Medical Center and St. Radboud University Medical Center. The project consists of four phases beginning with a literature review and patient file study to examine current knowledge and practice of medication management in the last phase of life. In the second phase we will carry out a clustered-interviews study to address the perspectives of patients, physicians, relatives and nurses with regard to problems encountered in the management of medication in the last three months of life. The third phase will consist of a survey study that will collect data from a broader population frame to validate the results of these interviews and a Delphi study to develop expert agreement focused on the current situation in the Netherlands. The results from these phases will be put together in the fourth phase which will focus on the identification and generation of clinically relevant recommendations to improve the practice of medication management in the last phase of life.
Promovendi: Drs. Bregje Huisman