Better drug use in advanced disease: An international Delphi study

Bregje A. A. Huisman, Eric C. T. Geijteman, Marianne K. Dees, Lia van Zuylen, Agnes van der Heide, Roberto S. G. M. Perez

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Patients with a limited life expectancy use many medications, some of which may be questionable. Objectives: To identify possible solutions for difficulties concerning medication management and formulate recommendations to improve medication management at the end of life. Methods: A two-round Delphi study with experts in the field of medication management and end-of-life care (based on ranking in the citation index in Web of Science and relevant publications). We developed a questionnaire with 58 possible solutions for problems regarding medication management at the end of life that were identified in previously performed studies. Results: A total of 42 experts from 13 countries participated. Response rate in the first round was 93%, mean agreement between experts for all solutions was 87 % (range 62%-100%); additional suggestions were given by 51%. The response rate in the second round was 74%. Awareness, education and timely communication about medication management came forward as top priorities for guidelines. In addition, solutions considered crucial by many of the experts were development of a list of inappropriate medications at the end of life and incorporation of recommendations for end-of-life medication management in disease-specific guidelines. Conclusions: In this international Delphi study, experts reached a high level of consensus on recommendations to improve medication management in end-of-life care. These findings may contribute to the development of clinical practice guidelines for medication management in end-of-life care.
Original languageEnglish
JournalBMJ Supportive & Palliative Care
DOIs
Publication statusE-pub ahead of print - 2018

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