What can I do?
Align treatment with the person’s goals and wishes, which may change over time.
Check that medications (and other treatments) used to manage comorbidities continue to provide benefit to the patient as their illness progresses, while minimising any burdens or harms.
Use the STOPPFrail list of criteria to help identify potentially inappropriate medicine use in frail older adults with limited life.
Discuss withdrawal of treatments and deprescribing of medications in the context of the wishes laid out in a person’s advance care directive.
Build a relationship with the person and their family/carer prior to discussing the withdrawal of treatment or the discontinuing of medications. This requires sensitivity to the person’s physical needs, values and goals as well as consideration of the impact on family/carers.
Explain the process of withdrawal and any potential issues from the withdrawal empathetically to the person and their family/carer - withdrawing treatment does not mean withdrawing care. Reassure the person and family that all measures to provide comfort and support will be continued. This includes attention to personal care, especially oral care and symptom relief. You can use these useful phrases (110kb pdf) where applicable.
Consider if other medicines are required to ensure comfort throughout the withdrawal period.
Pharmacists may be involved with palliative care in both hospital and community settings. If relevant, ask a pharmacist to conduct a Home Medicines Review (HMR) or a Residential Medication Management Review (RMMR)