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Original research
Better drug use in advanced disease: an international Delphi study
  1. Bregje A. A. Huisman1,
  2. Eric C. T. Geijteman2,3,
  3. Marianne K. Dees4,
  4. Lia van Zuylen2,
  5. Agnes van der Heide3 and
  6. Roberto S.G.M. Perez1
  1. 1 Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands
  2. 2 Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
  3. 3 Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
  4. 4 Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Drs. Bregje A. A. Huisman, Department of Anesthesiology, VU University Medical Center, Amsterdam 1081 HV, The Netherlands; b.huisman{at}vumc.nl

Abstract

Patients with a limited life expectancy use many medications, some of which may be questionable.

Objectives To identify possible solutions for difficulties concerning medication management and formulate recommendations to improve medication management at the end of life.

Methods A two-round Delphi study with experts in the field of medication management and end-of-life care (based on ranking in the citation index in Web of Science and relevant publications). We developed a questionnaire with 58 possible solutions for problems regarding medication management at the end of life that were identified in previously performed studies.

Results A total of 42 experts from 13 countries participated. Response rate in the first round was 93%, mean agreement between experts for all solutions was 87 % (range 62%–100%); additional suggestions were given by 51%. The response rate in the second round was 74%. Awareness, education and timely communication about medication management came forward as top priorities for guidelines. In addition, solutions considered crucial by many of the experts were development of a list of inappropriate medications at the end of life and incorporation of recommendations for end-of-life medication management in disease-specific guidelines.

Conclusions In this international Delphi study, experts reached a high level of consensus on recommendations to improve medication management in end-of-life care. These findings may contribute to the development of clinical practice guidelines for medication management in end-of-life care.

  • palliative care
  • end-of-life care
  • medication therapy management
  • drug utilization review
  • delphi technique
http://creativecommons.org/licenses/by-nc/4.0

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/bmjspcare-2018-001623

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    Footnotes

    • Deceased Dr Roberto Perez died on 7 September 2017

    • Contributors All authors conceived the study. All authors contributed to the study planning and design. BH contributed to data collection. BH analysed and interpreted the data with input from RP, AvdH, LvZ, EG and MD. BH wrote the manuscript with input and feedback from RP, AvdH, LvZ, EG and MD.

    • Funding This research study was undertaken within the framework of the Medication Management in the Last Phase of Life project which is funded by a grant from the Dutch government (ZonMw 80-82100-98-210).

    • Disclaimer The opinions expressed are those of the authors. The funding party did not influence any aspect of the study design, collection, analysis or interpretation of data, or decision to submit the manuscript for publication.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.