Patients with a life expectancy of less than three months due to a (chronic) disease often use many medications until shortly before they die. This is partly inevitable, because these patients often have multiple symptoms that need to be alleviated. However, for a considerable number of medications currently often used at the end of life, the benefit is debatable, e.g. because they are aimed at the long-term prevention of illness. The use of such potentially inappropriate medications (PIMs) can be both harmful and costly. Therefore, physicians should reconsider the use of medications in the last phase of life. In clinical practice such reconsideration is rare, however. Two main reasons are the absence of (randomized) studies on the consequences of such ‘de-prescribing’ and the lack of guidelines to support de-prescribing.
In this project we will investigate the effects of a digital decision support module, the so-called Clinical Rule Reporter (CRR), to guide physicians in medication prescription in the last phase of life of a patient. The CRR was developed to guide medication prescription and de-prescription in nursing homes. We will further develop it into a ‘CRR+’, to support physicians with medication prescriptions for patients with a life expectancy of less than three months, based on current literature. This study will focus on the use of PIMs. We will evaluate the effect of the CRR+ on patients’ quality of life, the occurrence of complications, patients’ survival and healthcare costs. Patients with a life expectancy of two weeks to three months will be asked to participate in a stepped wedge cluster randomized study. Two hospital departments, three hospice facilities and two home care organizations will participate as clusters.
The project will lead to practical guidelines to optimize medication use in the last phase of life, which can be widely implemented using a broadly applicable CRR+.