title: Soliciting an herbal medicine and supplement use history at hospice admission.
abstract: BACKGROUND
  Reconciling medication use and performing drug utilization review on admission of a patient into hospice care are essential in order to safely prescribe medications and to prevent possible adverse drug events and drug-drug interactions. As part of this process, fully assessing herbal medicine and supplement use in hospice patients is crucial, as patients in hospice may be likely to use these medications and may be more vulnerable to their potential adverse effects.
  
  
  OBJECTIVE
  Our purpose was to identify herbals, vitamins, and supplements that should be routinely assessed on every hospice admission because of their higher likelihood of use or higher risk of adverse effects or drug interactions.
  
  
  METHODS
  Experts in the fields of palliative medicine, pharmacy, and alternative medicine were asked to complete a Web-based survey on 37 herbals, vitamins, supplements, and natural products, rating likelihood of use, potential for harm, and recommendation to include it on the final list on a scale of 1 to 5 (least to most likely to agree).
  
  
  RESULTS
  Twenty experts participated in the survey. Using a cutoff of 3.75 for inclusion of a medication on the final list, 12 herbal medicines were identified that should be routinely and specifically assessed on hospice admission.
  
  
  CONCLUSIONS
  Although assessing all herbal medicine use is ideal, thorough detection of herbals may be challenging. The list of herbals and supplements identified by this survey could be a useful tool for medication reconciliation in hospice and could aid in identifying potentially harmful medication use at the end of life.
authors.affiliation: Department of General Internal Medicine, UT MD Anderson Cancer Center, Houston, Texas 77030, USA. hholmes@mdanderson.org
authors.forename: Holly M
authors.initials: HM
authors.lastname: Holmes
authors.forename: Karen
authors.initials: K
authors.lastname: Kaiser
authors.forename: Steve
authors.initials: S
authors.lastname: Jackson
authors.forename: Mary Lynn
authors.initials: ML
authors.lastname: McPherson
mesh_terms: D019587:Dietary Supplements; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel; D029001:Herbal Medicine; D017051:Hospice Care; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000592:standards*; D010343:Patient Admission; D017751:Safety Management