Overview of medication management in palliative care
Medication use in palliative care is principally aimed at managing symptoms, relieving distress and improving quality of life. Medication management in palliative care involves ensuring medications are taken properly and achieving the desired therapeutic outcome in line with the goals of care of the patient. Factors that influence medication management are listed in Factors that influence medication management for patients with palliative care needs.
Key factors | Examples |
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patient factors |
level of health literacy understanding of, attitudes to, and preferences about medication, including cultural attitudes stage of disease and prognosis comorbidities medication adherence ability to swallow ability to administer medications (eg inhalers, eye drops) dexterity carer support |
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place of care |
community, residential facility (disability or aged care), prison, hospital, palliative care unit (hospice) metropolitan, rural, remote |
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intent of medication |
disease modification symptom management (acute or chronic) preventive health care and general wellbeing (eg supplements, complementary medicines) |
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medication safety |
adverse drug reactions quantity of medication supplied medication storage and disposal nonmedical use of medication by patients or carers [NB1] |
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complexity of medication regimen |
use of a drug to treat multiple comorbidities involvement of multiple prescribers frequent changes to medications and doses drugs associated with a high risk of causing harm to patients combination of regular and as-required drug therapy complementary, alternative and over-the-counter therapies that patients commonly access without prescriber involvement |
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availability in different settings quantity and frequency of medication supply (eg for subcutaneous doses via continuous subcutaneous infusions [CSCI]) cost registered use or indication legislative restrictions (eg for opioids) | |
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Note: NB1: Nonmedical use describes the use of medications that does not align with the directed use; for example, use in order to become intoxicated or to treat a symptom other than the clinician intendedAustralian Institute of Health and Welfare (AIHW)McNeely, 2014.
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Safe and effective use of medications in patients with palliative care needs can be enhanced through:
- planning ahead to ensure continuity of care and timely access to drugs
- rapid review of medication regimens in response to changing symptoms
- communication between healthcare professionals and patients and carers to ensure consistency of prescribing and information, particularly when moving between care settings (see also Coordination of palliative care)
- educating and supporting patients and carers
- rationalising complex medication regimens and deprescribing.