Medication Discontinuation at the End of Life: A Questionnaire Study on Physicians' Experiences and Opinions

Background: Many patients who are in the last phase of life use multiple medications that are continued until shortly before they ultimately die. Little is known about physicians' opinions and experiences regarding medication discontinuation at the end of patients' lives. Objective: To explore physicians' opinions and experiences regarding medication discontinuation during the last phase of life, and to identify factors influencing the continuation of potentially inappropriate medications. Design: Questionnaire study, including a vignette and several statements. Setting/Subjects: A random sample of general practitioners and clinical specialists working in three regions in the Netherlands that represent more than half of the Dutch population. Results: Questionnaires were returned by 321 physicians (response rate: 37%). The majority of them (73%) agreed with the statement that patients who are in the last phase of life use too many medications. When presented with a vignette of a patient with end-stage COPD with different limited life expectancies, preventive medications would be stopped right early before death. Medications to relieve symptoms would not be stopped or stopped right before death. For medications to treat (chronic) illnesses, there was a huge interphysician variability. All statements about possible reasons why medications are continued in the last phase of life, for example, patients feeling abandoned and lack of time, were agreed upon by a small minority of respondents. Conclusions: Although physicians agree that patients use too many medications at the end of life, they quite regularly seem to give patients medications for chronic diseases, for which the benefit at the end of life may be debatable. More scientific evidence on whether or not these types of medication might be discontinued in the last phase of life is needed.

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