title: Medication use during end-of-life care in a palliative care centre.
abstract: BACKGROUND
  In end-of-life care, symptoms of discomfort are mainly managed by drug therapy, the guidelines for which are mainly based on expert opinions. A few papers have inventoried drug prescriptions in palliative care settings, but none has reported the frequency of use in combination with doses and route of administration.
  
  
  OBJECTIVE
  To describe doses and routes of administration of the most frequently used drugs at admission and at day of death. Setting Palliative care centre in the Netherlands.
  
  
  METHODS
  In this retrospective cohort study, prescription data of deceased patients were extracted from the electronic medical records.
  
  
  METHODS
  Doses, frequency and route of administration of prescribed drugs
  
  
  RESULTS
  All regular medication prescriptions of 208 patients, 89% of whom had advanced cancer, were reviewed. The three most prescribed drugs were morphine, midazolam and haloperidol, to 21, 11 and 23% of patients at admission, respectively. At the day of death these percentages had increased to 87, 58 and 50%, respectively. Doses of these three drugs at the day of death were statistically significantly higher than at admission. The oral route of administration was used in 89% of patients at admission versus subcutaneous in 94% at the day of death.
  
  
  CONCLUSIONS
  Nearing the end of life, patients in this palliative care centre receive discomfort-relieving drugs mainly via the subcutaneous route. However, most of these drugs are unlicensed for this specific application and guidelines are based on low level of evidence. Thus, there is every reason for more clinical research on drug use in palliative care.
authors: Pain Expertise Centre, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. a.masman@erasmusmc.nl.|Palliative Care Centre, Laurens Cadenza, Rotterdam, The Netherlands. a.masman@erasmusmc.nl.|Intensive Care, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Room SK 1276, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands. a.masman@erasmusmc.nl.
authors: Anniek D
authors: AD
authors: Masman
authors: Pain Expertise Centre, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.|Intensive Care, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Room SK 1276, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
authors: Monique
authors: M
authors: van Dijk
authors: Pain Expertise Centre, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.|Intensive Care, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Room SK 1276, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
authors: Dick
authors: D
authors: Tibboel
authors: Pain Expertise Centre, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.|Palliative Care Centre, Laurens Cadenza, Rotterdam, The Netherlands.
authors: Frans P M
authors: FP
authors: Baar
authors: Pain Expertise Centre, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.|Hospital Pharmacy - Clinical Pharmacology, Academic Medical Centre, Amsterdam, The Netherlands.
authors: Ron A A
authors: RA
authors: Mathôt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009426:Netherlands / Q000453:epidemiology; D010166:Palliative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*
keywords: Drug therapy; Drug utilization; Netherlands; Palliative care; Pharmaceutical preparations; Prescriptions; Terminal care