When a patient is admitted to Carroll Hospice, our care team performs a review of the medications he or she is taking. This review, which continues throughout the patient’s hospice journey, allows us to prescribe—and discontinue—medications, while adjusting to the patient’s individual needs.
Maximizing a patient’s comfort and quality of life is the focus of prescribing and stopping medications. Hospice’s philosophy of care emphasizes symptom management, rather than curative, aggressive approaches.
Careful consideration is given to every prescribed medication, and we make sure that each one is given in the best delivery method for the patient. For instance, many inhalers require manual dexterity as well as inhaling at just the right time, providing opportunity for error, whereas a nebulizer treatment may make it easier for the patient.
A period of adjustment and coming to terms with a new “normal” often occur for patients and their families in hospice care. Some patients have been taking certain medications for years and stopping their use seems counterintuitive. For example, in hospice care our aim is to only prevent hypo- and hyperglycemia in patients with diabetes. Continuing to aggressively treat cholesterol is not beneficial. And vitamins or supplements provide little benefit to a hospice patient and could interfere with the absorption of other medications.
It may be difficult for patients to give up certain medications that were initially prescribed for healthy living and prevention and not intended for end-of-life care. The care team and I work with each of our patients and their families to help them understand the reasons behind the changes in their medications, with the goal of comfort and quality care at the end of life.
John W. Middleton, M.D., is Carroll Hospice’s medical director.