This year’s Palliative Pearls case studies explored a variety of topics, from basic prescribing decisions to exploring the full continuum of care. If there’s a theme to be found among the three most popular installments of 2025, it’s how much hospice prescribing and practice really differ from other areas of healthcare.
For years, methadone’s value as an analgesic was overshadowed by its use in opioid use disorder treatment, but the hospice and palliative care sector has led the way in demonstrating the medication’s benefits. Crushing, opening and splitting medications are necessities in hospice due the prevalence of dysphagia at the end of life as well as the speed with which patient needs can change. Managing hiccups is often not a priority in curative care, since the condition is usually self-limiting, but hospice patients don’t have time to wait for troublesome issues to resolve.
Palliative Pearls is all about providing hospice clinicians with the most relevant information possible to maximize patient safety and comfort. You can sign up to receive Palliative Pearls in your inbox each month, plus Clinical Alerts and more. In the meantime, here are the three most-read Palliative Pearls articles of 2025:
Methadone as a Coanalgesic
This month’s case expands upon methadone as an adjuvant analgesic, or coanalgesic, a concept introduced in Methadone, Beyond the Basics and a common topic of clinical consultations with Enclara pharmacists. We will begin with a patient case and proceed with methadone considerations, connecting patient case attributes to the medication’s use as a coanalgesic.
Managing Hiccups at End of Life
Hiccups are involuntary, intermittent contractions of the diaphragm and intercostal muscles. The medical term for hiccups is singultus, which derives from the Latin “singult” meaning ‘to catch one’s breath while sobbing’. These contractions are often caused by irritation of the phrenic or vagus nerves, disturbances to the central nervous system (e.g., encephalitis, Parkinson’s disease, stroke), toxic or metabolic changes, medications, or psychological factors. While typically benign and self-limiting, hiccups can become a significant source of distress in hospice settings, impacting the quality of life of patients and their caregivers.
Crushing, Opening, and Splitting Oral Dosage Forms
Crushing, opening, and splitting oral dosage forms are commonly used strategies by patients, caregivers, and healthcare professionals to address the challenges posed by dysphagia, a prevalent concern in hospice care settings. While these techniques (i.e., dosage form manipulations) can be beneficial, it’s essential to understand which medications are safe to manipulate and the proper ways to do so. Incorrect handling of medications can lead to unexpected consequences or undesirable results and impact patients’ quality of life. Additionally, deprescribing of medications no longer aligned with patient goals can reduce swallowing burden for patients.
