title: Inappropriate prescribing of preventative medication in patients with life-limiting illness: a systematic review.
abstract: OBJECTIVE
  To systematically review the literature to examine the methods used to identify inappropriate prescribing of preventative medication in patients with life-limiting illness and to detail the nature of medications prescribed.
  
  
  METHODS
  A systematic literature search of 4 databases was undertaken (MEDLINE, EMBASE, CINAHL, PsycINFO) from inception to April 2015 to identify peer-reviewed, observational studies assessing inappropriate prescribing of preventative medication in patients with life-limiting illness. Inclusion criteria were: participants had a life-limiting illness; prescribed/dispensed/using preventative medication; medication appropriateness assessed as a specific study aim or outcome.
  
  
  RESULTS
  We found 19 studies meeting our eligibility criteria. The methods used to assess medication appropriateness included criteria developed for the elderly such as the Beers Criteria, and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, Delphi consensus and expert clinical opinion. Lipid-regulating drugs (12 studies), antihypertensive (11 studies) and antidiabetic medications (9 studies) were the most common classes of inappropriate medication identified.
  
  
  CONCLUSIONS
  Patients with life-limiting illnesses are prescribed preventative medications considered inappropriate in the context of diminished life expectancy. The way in which preventative medication appropriateness is assessed in patients with life-limiting illness varies considerably-with some methodologies utilising criteria previously developed for elderly populations. Given this lack of standardisation, improving the prescribing in this context requires an approach that is specifically designed and validated for populations with life-limiting illness.
authors.affiliation: Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Todd
authors.affiliation: Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Husband
authors.affiliation: St Benedict's Hospice and Centre for Specialist Palliative Care, Ryhope, Sunderland, UK.
authors.forename: Inga
authors.initials: I
authors.lastname: Andrew
authors.affiliation: Faculty of Pharmacy, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Sallie-Anne
authors.initials: SA
authors.lastname: Pearson
authors.affiliation: Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Lindsey
authors.affiliation: Division of Geriatric and Palliative Medicine, The University of Texas Health, Science Center at Houston, Houston, Texas, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Holmes
mesh_terms: D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006299:Health Services for the Aged; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D013727:Terminal Care
keywords: Clinical decisions; Symptoms and symptom management