One of the core values of hospice is engaging patients and their family members in care decisions as much as possible. That includes medication management. However, hospice clinicians sometimes focus more on the basics of administering drugs while placing less emphasis on why certain drugs are prescribed and how they work. Hospices can improve patient care and overall satisfaction with hospice services by explaining the basics of pharmacology and addressing common misconceptions. Enclara pharmacists recommend special attention and reinforcement around a variety of topics, including the five shared here.
Opioids Aren’t for All Types of Pain
Opioids are powerful pain blockers and commonly used in palliative care, but they don’t work for everything. When it comes to pain from inflammation (including in joints and due to tumors), corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) may be needed in addition to or instead of an opioid. Drugs for anxiety and depression are also prescribed for pain, but it’s important to reassure patients that it’s not because the pain is psychosomatic. Palliative care often relies on off-label and secondary indications for common drugs.
Many Medications Have Multiple Uses
We tend to associate most medications with a single use, but that’s usually inaccurate. Some of the most common medications in palliative care can treat multiple symptoms. Opioids are powerful painkillers, and they also treat dyspnea. Haloperidol is used (and sometimes overused) for delirium and agitation, but it can also relieve nausea. Educating patients and caregivers about the reason or reasons for prescribing various medications is important to help them feel secure in using these medications.
Steroids Can Have Wide-Ranging Effects
Corticosteroids can be administered in various forms to help relieve a variety of pulmonary, dermatological, and rheumatoid symptoms. Their powerful anti-inflammatory effects can reduce pain at the source. However, their side effects can be both a blessing and a curse in palliative care. Improvements in appetite and mood can be welcome changes for hospice patients. On the other hand, sleeplessness and mood swings can be troublesome. Patients and caregivers should be prepared for these effects and advised on best practices such as administering a daily dose in the morning rather than before bedtime.
Rectal Administration May Be Required
Rectal administration of medications has several advantages, particularly in hospice. This route avoids the first pass effect which can reduce a drug’s effectiveness. Also, many patients in hospice lose the ability to swallow, and sublingual or intravenous administration are not always an option. It’s understandable that family caregivers may be embarrassed or squeamish about this practice. They may also be uncomfortable with turning the patient safely. Nurses should provide education, reassurance and, when needed, appropriate equipment in the home to prepare caregivers for this task.
Some Drugs May Be Adjusted or Discontinued
It’s natural to expect new medications to be prescribed for symptom management in hospice. However, patients and caregivers are sometimes surprised when the hospice recommends stopping some medications. In many cases, fewer medications to manage will be a relief, but it’s also common to encounter some resistance. Hospice clinicians should explain how deprescribing can reduce risks of side effects and drug interactions. This is often a process, as some medications have benefits at earlier stages of terminal illness progression but are less helpful as care goals change.
Interested in learning more about these topics? Take a deeper dive with other Enclara Pharmacia resources.
- Benefits of Deprescribing for Patients Nearing End-of-Life
- Approach to Rectal Administration: A Refresher
- Dyspnea and Opioid Use