Validated medication deprescribing instruments for patients with palliative care needs: a systematic review

• Published in: Farmacia hospitalaria 2024-03, Vol.48 (2), p.83-89
• Main Authors: de Andrade, Frangie Kallas, Nunes, Raziel Prado Ignacio, Zanetti, Maria Olívia Barboza, Zanetti, Ariane Cristina Barboza, dos Santos, Márcia, de Oliveira, Alan Maicon, Carson-Stevens, Andrew, Pereira, Leonardo Régis Leira, Varallo, Fabiana Rossi
• Format: Article
• Language: English
• Subjects: Clinical protocols; Cuidados Paliativos; Deprescriptions; Desprescripción; Inappropriate prescribing; Palliative care; Patient safety; Prescripción Inadecuada; Protocolos Clínicos; Seguridad del Paciente
• ISSN: 1130-6343
• DOI: 10.1016/j.farma.2023.08.004

Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear. Los pacientes con enfermedades terminales son propensos a la polifarmacia innecesaria. Las herramientas de desprescripción pueden contribuir a minimizar los resultados negativos. Por lo tanto, los objetivos del estudio fueron identificar instrumentos validados para la desprescripción de medicamentos inapropiados en pacientes con necesidades de cuidados paliativos y evaluar el impacto en los resultados clínicos, humanísticos y eco