The belief that hospice care immediately stops all medications is a widespread misconception. Hospice care does not discontinue every drug; rather, it initiates a comprehensive review of the patient’s entire medication regimen upon admission. This evaluation ensures that every medication supports the primary goal of hospice: maximizing comfort and quality of life. The process involves adjusting or discontinuing treatments that no longer align with this goal, focusing instead on managing symptoms effectively.
Shift in Care Philosophy
The fundamental reason for the medication review is a shift in the goal of medical treatment, moving from a curative approach to a palliative one. Curative care focuses on extending life, slowing disease progression, and preventing future complications through aggressive treatments. Once a patient enters hospice, the focus changes entirely to comfort care, prioritizing the patient’s immediate physical and emotional well-being. This change means medications are evaluated solely on their ability to provide immediate relief and improve current quality of life. The hospice team seeks to reduce the overall “pill burden,” minimizing the risk of harmful drug interactions and uncomfortable side effects by stopping drugs that offer no tangible, short-term benefit.
Medications That Are Discontinued
Many medications are discontinued because their intended benefits no longer match the goals of comfort-focused care. Preventative medications, designed to reduce the risk of future health events, are usually stopped first. This includes statins, which lower cholesterol to prevent heart attack or stroke over a long period. Blood pressure medications (antihypertensives) and blood thinners (anticoagulants) are also frequently discontinued. The benefits of these drugs require a long time to materialize and, for a patient with a prognosis measured in months, they may cause harm, such as dizziness or increased risk of bleeding. Routine vitamins, supplements, and maintenance drugs for asymptomatic conditions are often stopped because they do not contribute to immediate comfort. Discontinuing these medications frees the patient from unnecessary side effects and complex dosing schedules.
Medications Essential for Comfort
While some medications are stopped, many others are continued, adjusted, or increased because they are essential for symptom management. Highest priority is given to drugs that relieve pain, the most common end-of-life symptom. Opioids, such as morphine or fentanyl, are commonly used and titrated to control severe pain and ease shortness of breath. Anxiolytics, like lorazepam (Ativan), are prioritized for reducing anxiety, agitation, and restlessness, helping patients remain calm and comfortable. Anti-nausea medications (antiemetics), such as ondansetron or haloperidol, are also crucial to manage vomiting and sickness that diminish quality of life. The hospice team ensures these comfort-focused drugs are readily available, often in a “comfort kit,” to address symptoms quickly.
How Medication Decisions Are Made
Medication decisions in hospice result from a collaborative, patient-centered process involving a multidisciplinary team. The hospice physician and registered nurse lead a comprehensive review of all current prescriptions, over-the-counter drugs, and supplements. This review is discussed openly with the patient and their family or primary caregiver. The patient’s goals and preferences drive all decisions, and no medication is discontinued without their consent or the consent of their legal representative. The team continuously monitors symptoms, adjusting dosages or reintroducing a discontinued medication if comfort is compromised, ensuring the plan remains flexible and aligned with the patient’s evolving needs.