Whether hospice care removes medications is a common concern for patients and families transitioning from curative treatment. Hospice shifts the primary goal from prolonging life and seeking a cure to maximizing comfort and quality of life. This change necessitates a comprehensive re-evaluation of all current medications to align them with patient-centered goals. The process involves discontinuing certain drugs, known as deprescribing, while prioritizing and often increasing medications dedicated to symptom relief.
The Shift from Curative to Comfort Goals
The fundamental difference in medication management stems from contrasting medical philosophies. Curative care aims for long-term health and survival, while hospice care focuses on palliative measures and immediate comfort. Many medications are prescribed years in advance to prevent future health crises, such as a heart attack or stroke, and require months or years of consistent use before their full benefit is realized.
When a patient enters hospice, their prognosis is typically measured in months, rendering the long-term preventive benefits of certain drugs obsolete. Continuing medications whose intended effect is contingent on a time horizon the patient is unlikely to meet introduces unnecessary risks without corresponding benefit. This process reduces the “pill burden,” which is the sheer number of doses a patient must take daily.
Taking numerous medications increases the risk of adverse drug-drug interactions and unwanted side effects, diminishing the patient’s quality of life. The shift in focus minimizes the negative consequences of polypharmacy, the use of multiple medications that may no longer be appropriate. By eliminating non-beneficial drugs, the hospice team can better manage the medications that truly support comfort.
Which Medications Are Discontinued
Medications most commonly targeted for discontinuation are those prescribed for primary or secondary prevention of future medical events. Cholesterol-lowering drugs, specifically statins, are frequently stopped because their cardiovascular benefits require years to accrue. Continuing statins risks side effects like muscle pain or gastrointestinal issues without providing the intended long-term protection.
Many medications for chronic, stable conditions, such as certain antihypertensives for high blood pressure, are also often tapered or discontinued. Prophylactic treatments like aspirin, used to prevent blood clots, and vitamins or nutritional supplements are frequently reviewed and stopped. The potential for these drugs to cause bleeding complications or add to the pill burden often outweighs any benefit in advanced illness.
Specific diabetes medications, particularly oral hypoglycemics, may be discontinued because patients naturally begin to eat and drink less near the end of life. Maintaining strict blood sugar control becomes less important than avoiding the risk of hypoglycemia, which causes distressing symptoms like confusion and weakness. The goal is to avoid the adverse effects of maintenance drugs that no longer serve a meaningful purpose.
Prioritizing Symptom and Comfort Management
While some medications are removed, hospice aggressively shifts focus to maintaining a robust regimen of comfort-focused medications, often called a comfort kit. These drugs are added or increased to ensure rapid and effective management of symptoms that commonly cause distress near the end of life. Pain management is a primary focus, often involving opioid analgesics like morphine, which is a first-line drug for moderate to severe pain.
Morphine is also utilized effectively at low doses to manage severe shortness of breath, or dyspnea, by altering the central nervous system’s perception of air hunger. This approach provides relief from the sensation of struggling to breathe, a common and frightening symptom. Non-opioid pain relievers like acetaminophen are maintained for mild to moderate discomfort.
Anxiety and agitation are managed using anxiolytics, with lorazepam being a common choice for promoting calmness and easing restlessness. Antiemetics, such as ondansetron or haloperidol, are prioritized to control nausea and vomiting caused by disease progression or other medications. For patients experiencing noisy breathing due to fluid in the airways, anticholinergic medications like glycopyrrolate or scopolamine patches are employed to help dry up secretions.
The hospice team is expert in the titration, or careful adjustment, of these comfort medications to ensure symptoms are addressed quickly and effectively. This specialized approach ensures the patient’s quality of life is maintained without delay, using a combination of drugs tailored to their specific needs. The goal is to provide immediate, sustained relief from physical or emotional distress.
Patient and Family Involvement in Medication Planning
Medication review and adjustment in hospice care is a collaborative effort, not a unilateral decision made by the provider. It involves the patient, their family, and the interdisciplinary hospice team. This team typically includes a physician or nurse practitioner, a registered nurse, and a pharmacist, who plays an important role in medication optimization.
The pharmacist conducts a comprehensive medication review upon admission to evaluate every drug for appropriateness, potential interactions, and side effects. This review is mandated to occur regularly, often every fifteen days, ensuring the regimen continues to meet the patient’s changing needs. The team discusses the rationale for deprescribing preventive drugs and prioritizing comfort medications, providing education to ease anxiety about the changes.
Patient autonomy is paramount, and decisions about stopping or starting medications are made through shared decision-making. While the team provides strong evidence-based recommendations, the patient’s wishes regarding non-palliative medications they want to continue are respected. This is provided those drugs do not interfere with the overall comfort plan, ensuring the process is transparent, respectful, and focused on the patient’s ultimate goals.