COLLABORATIVE DEPRESCRIBING IN PALLIATIVE CARE: A MULTIDISCIPLINARY APPROACH TO MEDICATION OPTIMISATION
European Statement
Clinical Pharmacy Services
Author(s)
A Wagner, D Weixler, C Waidinger, M Josl
Why was it done?
A pharmacist, integrated in the palliative care team, reviewed preselected patients with advanced disease to identify potentially inappropriate medications (PIMs). When appropriate, a team of physicians deprescribed PIMs in accordance to patient preferences, clinical status and rationale. The initiative aimed to identify PIMs, reduce pill burden and align pharmacotherapy with individual treatment goals.
What was done?
Up to 96% of geriatric oncological palliative care patients experience polypharmacy (>5 medications) (1), with up to 70% receiving at least one PIM referring to Lindsay J et al. (2).
Deprescribing is considered appropriate in certain clinical situations, including for example:
– presence of polypharmacy
– patient’s wish
– shift in treatment strategy or goals
– limited life expectancy
– when potential harm outweighs benefits
How was it done?
– Weekly interdisciplinary meetings
– Eligible patients were identified by the palliative care physicians based on prognosis, symptom burden, medication profile (polypharmacy), and patient wishes
– Pharmacist reviewed medications using medical records, identified potential deprescribing opportunities and provided tailored deprescribing recommendations (what and how to deprescribe)
– Recommendations were collaboratively discussed and documented
– If deprescribing was implemented, follow-up was conducted at the next patient visit and was subsequently monitored during regular consultations
What has been achieved?
During observation period, three patients (all male, median age 80) received a structure deprescribing review. A total of 59 drugs were targeted, 20 PIMs have been identified.
Commonly deprescribed medication groups were gastroprotective drugs (A02B), urological agents (G04B, G04C) antihypertensives (C02A, C09A, C08C, C03C) and vascular or miscellaneous agents (C05B, N06DX, N07A). Typical reason for discontinuation included stable blood pressure, presence of indwelling urinary catheter, patient-driven deprescribing request, therapeutic futility.
Other drug classes such as psychotropics (N06A, N04B), cognitive enhancers (N06D) and bone-metabolism agents (M05B, A12A) were occasionally discontinued when adverse drug effects outweighed potential benefit or did not align with palliative goals (long-term preventive therapy). Main drivers for deprescribing were patient wishes to reduce pill burden, complex symptom management and avoidance of adverse effects.
What next?
The initiative demonstrated feasibility, safety, and transferability of pharmacist-supported deprescribing as part of a multidisciplinary team. Next steps could include the development of interprofessional training sessions and expansion to other clinical settings.
MEDSAWARE: DEPRESCRIBING ACTION WEEK, IMPACTS AND GROWTH
Pdf
European Statement
Clinical Pharmacy Services
Author(s)
Kristin Michaels, Chief Executive
Tom Simpson, President
Why was it done?
Polypharmacy and medication overuse remain critical concerns in modern healthcare, often leading to adverse drug events, increased hospitalisations, and diminished quality of life, particularly among the elderly. Recognising the need for improved medication management and patient safety, Advanced Pharmacy Australia initiated MedsAware: Deprescribing Action Week in 2022. The initiative aimed to promote awareness and education on deprescribing practices to optimise pharmacotherapy and reduce the burden of unnecessary medications.
What was done?
MedsAware: Deprescribing Action Week is an annual, nationwide campaign involving a series of educational programs, workshops, and collaborative efforts with healthcare professionals. The initiative provided evidence-based resources, clinical guidelines, and decision-support tools to pharmacists, physicians, and other stakeholders, and promoted key messages to patients around deprescribing and quality use of medicines. It also facilitated interdisciplinary forums to discuss strategies for implementing deprescribing protocols within various healthcare settings.
How was it done?
The initiative employed a multifaceted approach combining digital platforms, live seminars, and interactive workshops. Educational materials were disseminated through webinars, online modules, and social media outreach to maximize accessibility. Collaborative partnerships were established with hospitals, clinics, and professional organisations to integrate deprescribing practices into routine care.
What has been achieved?
MedsAware Deprescribing Action Week is about driving conversations around discontinuing medicines that are no longer required, or for which the risk of harm outweighs the benefits.
MedsAware seeks to raise awareness around ‘polypharmacy’ and ‘deprescribing’, empowering Australians and their care teams to manage every medicines regimen ensuring it is current, effective and safe.
#MedsAware supports and raises awareness of Australia’s 10th National Health Priority Area, Quality Use of Medicines and Medicines Safety.
What next?
Building on the momentum, Advanced Pharmacy Australia continues its annual MedsAware: Deprescribing Action Week to continually promote best practices, with the addition of the EAHP through MoU making the initiative global. In 2025, MedsAware turns its attention towards sustainability highlighting the benefits of deprescribing that can be felt all around us – for patient and planet. Future efforts will focus on longitudinal studies to assess the sustained impact of deprescribing interventions on patient health outcomes. Additionally, the development of an Australian national deprescribing framework is proposed, aiming to standardise practices and facilitate integration into healthcare policies and education curricula.