Verpleegkunde Nummer 4 , pp. 31-35
dec 2019, jaargang 34
Verpleegkunde Nr. 4 , pp. 31-35
dec 2019, jr. 34
Proefschrift

Deprescribing aan het einde van het leven

Een onderzoek bij volwassenen met een verminderde levensverwachting

Bij mensen met een verminderde levensverwachting, zoals patiënten met vergevorderde kanker die palliatief verzorgd worden, veranderen de zorg- en behandelingsdoelen van genezing naar verzorging en van kwantiteit naar kwaliteit van leven. Dit moet ook zichtbaar zijn in het gebruik van geneesmiddelen. De behandeling van de symptoomlast is cruciaal om de kwaliteit van leven te behouden en te verbeteren (1). Daarom moet het geneesmiddelengebruik in palliatieve zorg gefocust zijn op het behandelen van symptomen die onderbehandeld zijn en op het voorkomen van bijkomende schade veroorzaakt door geneesmiddelen die misschien niet meer nodig zijn, of deprescribing (2).

Literatuur

  1. World Health Organization. Definition of palliative care 2012. Te raadplegen op: http://www.who.int/cancer/palliative/definition/en/
  2. Paque K, et al. Barriers and enablers to deprescribing in people with life-limiting disease: a systematic review. Palliat Med 2019;33:37-48.
  3. Einav L, et al. Predictive modelling of U.S. health care spending in late life. Science 2018;360:1462-5.
  4. World Health Organization. WHO model list of essential medicine 2017. Te raadplegen op: http://apps.who.int/iris/bitstream/handle/10665/273826/EML-20-eng.pdf?ua=1
  5. De Lima L. International association for hospice and palliative care list of essential medicines for palliative care. Ann Oncol 2007;18:395-9.
  6. Morin L, et al. Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a European expert consensus. Eur J Clin Pharmacol 2018;74:1333-42.
  7. Van der Meer HG, et al. Changes in prescribing symptomatic and preventive medications in the last year of life in older nursing home residents. Front Pharmacol 2017;8:990.
  8. Masman AD, et al. Medication use during end-of-life care in a palliative care centre. Int J Clin Pharm 2015;37:767-75.
  9. Sera L, et al. Commonly prescribed medications in a population of hospice patients. Am J Hosp Palliat Care 2014;31:126-31.
  10. Van Nordennen RT, et al. Changes in prescribed drugs between admission and the end of life in patients admitted to palliative care facilities. J Am Med Dir Assoc 2016;17:514-8.
  11. Veehof L, et al. The development of polypharmacy. A longitudinal study. Family Practice 2000;17:261-7.
  12. Russell BJ, et al. Prescribing for comorbid disease in a palliative population: focus on the use of lipid-lowering medications. Intern Med J 2014;44:177-84.
  13. Heppenstall CP, et al. Medication use and potentially inappropriate medications in those with limited prognosis living in residential aged care. Australas J Ageing 2016;35:E18-24.
  14. Kotlinska-Lemieszek A, et al. Polypharmacy in patients with advanced cancer and pain: a European cross-sectional study of 2282 patients. J Pain Symptom Manage 2014;48:1145-59.
  15. McNeil MJ, et al. The burden of polypharmacy in patients near the end of life. J Pain Symptom Manage 2016;51:178-83.e2.
  16. Mangin D, et al. International group for reducing inappropriate medication use & polypharmacy (IGRIMUP): position statement and 10 recommendations for action. Drugs Aging 2018;35:575-87.
  17. Sevilla-Sanchez D, et al. Adverse drug events in patients with advanced chronic conditions who have a prognosis of limited life-expectancy at hospital admission. Eur J Clin Pharmacol 2017;73:79-89.
  18. Frechen S, et al. Drug interactions in dying patients: a retrospective analysis of hospice inpatients in Germany. Drug Saf 2012;35:745-58.
  19. Gaertner J, et al. Drug interactions in palliative care – It’s more than cytochrome P450. Palliat Med 2012;26:813-25.
  20. Agar M, et al. Changes in anticholinergic load from regular prescribed medications in palliative care as death approaches. Palliat Med 2009;23:257-65.
  21. Duran CE, et al. Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol 2013;69:1485-96.
  22. Domingues D, et al. Therapeutic futility in cancer patients at the time of palliative care transition: an analysis with a modified version of the Medication Appropriateness Index. Palliat Med 2015;29:643-51.
  23. Luymes CH, et al. Deprescribing preventive cardiovascular medication in patients with predicted low cardiovascular disease risk in general practice – the ECSTATIC study: a cluster randomized non-inferiority trial. BMC Med 2018;16(1):5.
  24. Kutner JS, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med 2015;175:691-700.
  25. Dewhurst F, et al. Blood pressure evaluation and review of antihypertensive medication in patients with life limiting illness. Int J Clin Pharm 2016;38:1044-7.
  26. Black CD, et al. Lack of evidence to guide deprescribing of antihyperglycemics: a systematic review. Diabetes Ther 2017;8:23-31.
  27. O’Mahony D, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 2015;44:213-8.
  28. Lavan AH, et al. STOPPFrail (Screening tool of older persons prescriptions in frail adults with limited life-expectancy): consensus validation. Age Ageing 2017;46:600-7.
  29. Cochrane handbook for systematic reviews of interventions version 5.1.0.2011. Te raadplegen op: http://training.cochrane.org/handbook
  30. Barnett K, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012;380:37-43.
  31. Chen LK, et al. Frailty is a geriatric symptom characterized by multiple impairments: a comprehensive approach is needed. J Frailty Aging 2016;5:208-13.
  32. Hogan DB, et al. A scoping review of frailty and acute care in middle-aged and older individuals with recommendations for future research. Can Geriatr J 2017;20:22-37.
  33. Marcucci M, et al. Defining aging phenotypes and related outcomes: clues to recognize frailty in hospitalized older patients. J Gerontol A Biol Sci Med Sci 2017;72:395-402.
  34. Fried TR, et al. Health outcomes associated with polypharmacy in community dwelling older adults: a systematic review. J Am Geriatr Soc 2014;62:2261-72.
  35. Pharmacodynamics and pharmacokinetics. Te raadplegen op: https://www.mheducation.co.uk/openup/chapters/9780335245659.pdf
  36. Hjaltadottir I, et al. Predicting mortality of residents at admission to nursing home: a longitudinal cohort study. BMC Health Serv Res 2011;11:86.
  37. Lee JS, et al. Survival prediction in nursing home residents using the Minimum Data Set subscales: ADL Self- Performance Hierarchy, Cognitive Performance and the Changes in Health, End-stage disease and Symptoms and Signs scales. Eur J Public Health 2009;19:308-12.
  38. Schlesinger A, et al. Does polypharmacy in nursing homes affect long-term mortality? J Am Geriatr Soc 2016;64:1432-8.
  39. Paque K, et al. Changes in medication use in a cohort of patients with advanced cancer: the international multicenter prospective European Palliative Care Cancer Symptom study. Palliat Med 2018;32:775-85.

Meer informatie

Het volledige proefschrift is te downloaden via: http://www.endoflifecare.be/publication/deprescribing-medications-end-life

Proefschrift

Deprescribing aan het einde van het leven

Een onderzoek bij volwassenen met een verminderde levensverwachting

Bij mensen met een verminderde levensverwachting, zoals patiënten met vergevorderde kanker die palliatief verzorgd worden, veranderen de zorg- en behandelingsdoelen van genezing naar verzorging en van kwantiteit naar kwaliteit van leven. Dit moet ook zichtbaar zijn in het gebruik van geneesmiddelen. De behandeling van de symptoomlast is cruciaal om de kwaliteit van leven te behouden en te verbeteren (1). Daarom moet het geneesmiddelengebruik in palliatieve zorg gefocust zijn op het behandelen van symptomen die onderbehandeld zijn en op het voorkomen van bijkomende schade veroorzaakt door geneesmiddelen die misschien niet meer nodig zijn, of deprescribing (2).

Literatuur

  1. World Health Organization. Definition of palliative care 2012. Te raadplegen op: http://www.who.int/cancer/palliative/definition/en/
  2. Paque K, et al. Barriers and enablers to deprescribing in people with life-limiting disease: a systematic review. Palliat Med 2019;33:37-48.
  3. Einav L, et al. Predictive modelling of U.S. health care spending in late life. Science 2018;360:1462-5.
  4. World Health Organization. WHO model list of essential medicine 2017. Te raadplegen op: http://apps.who.int/iris/bitstream/handle/10665/273826/EML-20-eng.pdf?ua=1
  5. De Lima L. International association for hospice and palliative care list of essential medicines for palliative care. Ann Oncol 2007;18:395-9.
  6. Morin L, et al. Adequate, questionable, and inadequate drug prescribing for older adults at the end of life: a European expert consensus. Eur J Clin Pharmacol 2018;74:1333-42.
  7. Van der Meer HG, et al. Changes in prescribing symptomatic and preventive medications in the last year of life in older nursing home residents. Front Pharmacol 2017;8:990.
  8. Masman AD, et al. Medication use during end-of-life care in a palliative care centre. Int J Clin Pharm 2015;37:767-75.
  9. Sera L, et al. Commonly prescribed medications in a population of hospice patients. Am J Hosp Palliat Care 2014;31:126-31.
  10. Van Nordennen RT, et al. Changes in prescribed drugs between admission and the end of life in patients admitted to palliative care facilities. J Am Med Dir Assoc 2016;17:514-8.
  11. Veehof L, et al. The development of polypharmacy. A longitudinal study. Family Practice 2000;17:261-7.
  12. Russell BJ, et al. Prescribing for comorbid disease in a palliative population: focus on the use of lipid-lowering medications. Intern Med J 2014;44:177-84.
  13. Heppenstall CP, et al. Medication use and potentially inappropriate medications in those with limited prognosis living in residential aged care. Australas J Ageing 2016;35:E18-24.
  14. Kotlinska-Lemieszek A, et al. Polypharmacy in patients with advanced cancer and pain: a European cross-sectional study of 2282 patients. J Pain Symptom Manage 2014;48:1145-59.
  15. McNeil MJ, et al. The burden of polypharmacy in patients near the end of life. J Pain Symptom Manage 2016;51:178-83.e2.
  16. Mangin D, et al. International group for reducing inappropriate medication use & polypharmacy (IGRIMUP): position statement and 10 recommendations for action. Drugs Aging 2018;35:575-87.
  17. Sevilla-Sanchez D, et al. Adverse drug events in patients with advanced chronic conditions who have a prognosis of limited life-expectancy at hospital admission. Eur J Clin Pharmacol 2017;73:79-89.
  18. Frechen S, et al. Drug interactions in dying patients: a retrospective analysis of hospice inpatients in Germany. Drug Saf 2012;35:745-58.
  19. Gaertner J, et al. Drug interactions in palliative care – It’s more than cytochrome P450. Palliat Med 2012;26:813-25.
  20. Agar M, et al. Changes in anticholinergic load from regular prescribed medications in palliative care as death approaches. Palliat Med 2009;23:257-65.
  21. Duran CE, et al. Systematic review of anticholinergic risk scales in older adults. Eur J Clin Pharmacol 2013;69:1485-96.
  22. Domingues D, et al. Therapeutic futility in cancer patients at the time of palliative care transition: an analysis with a modified version of the Medication Appropriateness Index. Palliat Med 2015;29:643-51.
  23. Luymes CH, et al. Deprescribing preventive cardiovascular medication in patients with predicted low cardiovascular disease risk in general practice – the ECSTATIC study: a cluster randomized non-inferiority trial. BMC Med 2018;16(1):5.
  24. Kutner JS, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med 2015;175:691-700.
  25. Dewhurst F, et al. Blood pressure evaluation and review of antihypertensive medication in patients with life limiting illness. Int J Clin Pharm 2016;38:1044-7.
  26. Black CD, et al. Lack of evidence to guide deprescribing of antihyperglycemics: a systematic review. Diabetes Ther 2017;8:23-31.
  27. O’Mahony D, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 2015;44:213-8.
  28. Lavan AH, et al. STOPPFrail (Screening tool of older persons prescriptions in frail adults with limited life-expectancy): consensus validation. Age Ageing 2017;46:600-7.
  29. Cochrane handbook for systematic reviews of interventions version 5.1.0.2011. Te raadplegen op: http://training.cochrane.org/handbook
  30. Barnett K, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012;380:37-43.
  31. Chen LK, et al. Frailty is a geriatric symptom characterized by multiple impairments: a comprehensive approach is needed. J Frailty Aging 2016;5:208-13.
  32. Hogan DB, et al. A scoping review of frailty and acute care in middle-aged and older individuals with recommendations for future research. Can Geriatr J 2017;20:22-37.
  33. Marcucci M, et al. Defining aging phenotypes and related outcomes: clues to recognize frailty in hospitalized older patients. J Gerontol A Biol Sci Med Sci 2017;72:395-402.
  34. Fried TR, et al. Health outcomes associated with polypharmacy in community dwelling older adults: a systematic review. J Am Geriatr Soc 2014;62:2261-72.
  35. Pharmacodynamics and pharmacokinetics. Te raadplegen op: https://www.mheducation.co.uk/openup/chapters/9780335245659.pdf
  36. Hjaltadottir I, et al. Predicting mortality of residents at admission to nursing home: a longitudinal cohort study. BMC Health Serv Res 2011;11:86.
  37. Lee JS, et al. Survival prediction in nursing home residents using the Minimum Data Set subscales: ADL Self- Performance Hierarchy, Cognitive Performance and the Changes in Health, End-stage disease and Symptoms and Signs scales. Eur J Public Health 2009;19:308-12.
  38. Schlesinger A, et al. Does polypharmacy in nursing homes affect long-term mortality? J Am Geriatr Soc 2016;64:1432-8.
  39. Paque K, et al. Changes in medication use in a cohort of patients with advanced cancer: the international multicenter prospective European Palliative Care Cancer Symptom study. Palliat Med 2018;32:775-85.

Meer informatie

Het volledige proefschrift is te downloaden via: http://www.endoflifecare.be/publication/deprescribing-medications-end-life

Over dit artikel
Auteur
Kristel Paque
Over de auteur

Dr. Kristel Paque behaalde een bachelordiploma verpleegkunde (1996) aan de Provinciale Hogeschool Limburg en master in verpleegkunde en vroedkunde aan de Universiteit Antwerpen (2014). In september 2016 startte zij met een dubbeldoctoraat over afbouwen/stoppen van geneesmiddelen aan het einde van het leven bij de onderzoeksgroep voor klinische farmacologie van het Heymans Instituut voor Farmacologie, Universiteit Gent, en de onderzoeksgroep Zorg rond het Levenseinde van de Vrije Universiteit Brussel en Universiteit Gent. Haar werk werd gefinancierd via interne financiering van beide onderzoeksgroepen. Het beschreven onderzoek werd begeleid door prof. dr. Thierry Christiaens (Universiteit Gent), prof. dr. Luc Deliens (Vrije Universiteit Brussel), en prof. dr. Koen Pardon (Vrije Universiteit Brussel).

Correspondentieadres: kristel.paque@telenet.be

Printdatum
13 december 2019
E-pubdatum
16 december 2019
ISSN print
0920-3273
ISSN online
2468-2225


Over dit artikel
Auteur
Kristel Paque
Over de auteur

Dr. Kristel Paque behaalde een bachelordiploma verpleegkunde (1996) aan de Provinciale Hogeschool Limburg en master in verpleegkunde en vroedkunde aan de Universiteit Antwerpen (2014). In september 2016 startte zij met een dubbeldoctoraat over afbouwen/stoppen van geneesmiddelen aan het einde van het leven bij de onderzoeksgroep voor klinische farmacologie van het Heymans Instituut voor Farmacologie, Universiteit Gent, en de onderzoeksgroep Zorg rond het Levenseinde van de Vrije Universiteit Brussel en Universiteit Gent. Haar werk werd gefinancierd via interne financiering van beide onderzoeksgroepen. Het beschreven onderzoek werd begeleid door prof. dr. Thierry Christiaens (Universiteit Gent), prof. dr. Luc Deliens (Vrije Universiteit Brussel), en prof. dr. Koen Pardon (Vrije Universiteit Brussel).

Correspondentieadres: kristel.paque@telenet.be

Printdatum
13 december 2019
E-pubdatum
16 december 2019
ISSN print
0920-3273
ISSN online
2468-2225