RT Journal Article
SR Electronic
T1 Better drug use in advanced disease: an international Delphi study
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP bmjspcare-2018-001623
DO 10.1136/bmjspcare-2018-001623
A1 Bregje A. A. Huisman
A1 Eric C. T. Geijteman
A1 Marianne K. Dees
A1 Lia van Zuylen
A1 Agnes van der Heide
A1 Roberto S.G.M. Perez
YR 2018
UL http://spcare.bmj.com/content/early/2018/11/15/bmjspcare-2018-001623.abstract
AB 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.