A very engaging conversational topic was presented.
Some key items to be considered at this point in a patient’s illness:
- Ambulatory, Palliative, Hospice or Comfort Care
- The Goals of Care as described by the patient/family
- Clinical Expertise
- Best Practice Evidence
Barriers may include:
- Patient Related: psychological attachment to medications they have been taking as well as families perception of effectiveness
- Clinician Related: Concern about patient’s/other clinicians resistance to change; Prescribing as a social expression of caring and concern
- System Related: Lack of data to support discontinuation of medications no consensus
Consider diagnosis and disease trajectory and when reviewing medications the:
Indication
Risks
Benefits
Consider first stopping OTC medications (remember patients thoughts about quality of life)
What are your thoughts about inhalers and nebulizers?
Do you sometimes feel the need to change their minds and convince them, negotiations???
Would early palliative care maybe help in later decisions about care goals and later discontinuation of medications?
Cost and effects of medications and some of the touchy ones such as Aricept and Namenda when families want the patient to still recognize them
Three thought provoking cases were presented that might also generate good discussions in your own teams. It did in our session. No right or wrong answers but a good way to determine for your team are best to support your patients.