Deprescribing in the context of limited life expectancy

What do we know about this topic area?

Many medicines have long-term benefits and prevent illness. However, in the last few weeks of a person’s life, when it is clear they will die soon, medicines are often stopped. Over the last year or two of life, the benefit of continuing to take long-term medicines maybe small and no longer helpful. Stopping medicines at this stage might improve quality of life, reduce side effects and treatment burden. At this time, it could be reasonable to talk to patients about stopping medicines. In order to do this sensitively and effectively, there is a need to find out what information would help doctors and patients to make decisions to stop medicines. Also, it would be helpful to know more about how and when doctors and patients would prefer to have conversations about stopping long-term medicines in the context of limited life expectancy (the last one to two years of life).

The aim of this study is to explore patient, carer, GP and pharmacist views about using information on the benefits and harms of long-term medicines, to inform decisions about whether a patient with limited life expectancy should stop some or all their medicines.

What we plan to do?

1. Interview 20 patients aged 65 years and over, taking 2 or more long-term medicines, 10-15 carers, and up to 15 primary care-based GPs and pharmacists. We will ask them if they think it is acceptable to talk about life expectancy and the risks/benefits of long-term medicines when talking about stopping these medicines. We will seek their views on what information would be most helpful to support shared decision making for stopping medicines and when and how such conversations should happen.

2. Hold meetings with an expert working group (including patients, carers, healthcare professionals) to review findings from the interviews. Based upon the findings, the group will develop resources for use in clinical practice to help doctors and patients make decisions about stopping long-term medicines that may no longer be of benefit to the patient. We will share the resources with a larger group of stakeholders to seek feedback. The resources will be tested in a future study to find out how they can be best used in clinical practice to improve patient care.

What will be done with the findings?

We will work closely with members of the public and patients to ensure their views inform the research design, interpretation of findings, and how best to publicise results. Findings and resources will be shared with patients, healthcare providers and policymakers (who decide how health services are provided) via the study website, social media and through publication in journals and presentations at conferences and meetings.

Amount Awarded: £147,899