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Methodological Challenges for Epidemiologic Studies of Deprescribing at the End of Life

Tjia, Jennifer
Lund, Jennifer L.
Mack, Deborah
Mbrah, Attah
Yuan, Yiyang
Chen, Qiaoxi
Osundolire, Seun
McDermott, Cara L.
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Abstract

Purpose of Review: To describe approaches to measuring deprescribing and associated outcomes in studies of patients approaching end of life (EOL).

Recent Findings: We reviewed studies published through 2020 that evaluated deprescribing in patients with limited life expectancy and approaching EOL. Deprescribing includes reducing the number of medications, decreasing medication dose(s), and eliminating potentially inappropriate medications. Tools such as STOPPFrail, OncPal, and the Unnecessary Drug Use Measure can facilitate deprescribing. Outcome measures vary and selection of measures should align with the operationalized deprescribing definition used by study investigators.

Summary: EOL deprescribing considerations include medication appropriateness in the context of patient goals for care, expected benefit from medication given life expectancy, and heightened potential for medication-related harm as death nears. Additional data are needed on how EOL deprescribing impacts patient quality of life, caregiver burden, and out-of-pocket medication-related costs to patients and caregivers. Investigators should design deprescribing studies with this information in mind.

Source

Tjia J, Lund JL, Mack DS, Mbrah A, Yuan Y, Chen Q, Osundolire S, McDermott CL. Methodological Challenges for Epidemiologic Studies of Deprescribing at the End of Life. Curr Epidemiol Rep. 2021 Sep;8(3):116-129. doi: 10.1007/s40471-021-00264-7. Epub 2021 Apr 23. PMID: 34722115; PMCID: PMC8553236. Link to article on publisher's site

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10.1007/s40471-021-00264-7
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34722115
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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.