title: 'I don't think I'd be frightened if the statins went': a phenomenological qualitative study exploring medicines use in palliative care patients, carers and healthcare professionals.
abstract: BACKGROUND
  There is a growing body of evidence suggesting patients with life-limiting illness use medicines inappropriately and unnecessarily. In this context, the perspective of patients, their carers and the healthcare professionals responsible for prescribing and monitoring their medication is important for developing deprescribing strategies. The aim of this study was to explore the lived experience of patients, carers and healthcare professionals in the context of medication use in life-limiting illness.
  
  
  METHODS
  In-depth interviews, using a phenomenological approach: methods of transcendental phenomenology were used for the patient and carer interviews, while hermeneutic phenomenology was used for the healthcare professional interviews.
  
  
  RESULTS
  The study highlighted that medication formed a significant part of a patient's day-to-day routine; this was also apparent for their carers who took on an active role-as a gatekeeper of care-in managing medication. Patients described the experience of a point in which, in their disease journey, they placed less importance on taking certain medications; healthcare professionals also recognize this and refer it as a 'transition'. This point appeared to occur when the patient became accepting of their illness and associated life expectancy. There was also willingness by patients, carers and healthcare professionals to review and alter the medication used by patients in the context of life-limiting illness.
  
  
  CONCLUSIONS
  There is a need to develop deprescribing strategies for patients with life-limiting illness. Such strategies should seek to establish patient expectations, consider the timing of the discussion about ceasing treatment and encourage the involvement of other stakeholders in the decision-making progress.
authors.affiliation: Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Thornaby, Stockton-on-Tees, TS17 6BH, UK. adam.todd@durham.ac.uk.
authors.forename: Adam
authors.initials: A
authors.lastname: Todd
authors.affiliation: Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center, Houston, TX, USA. Holly.M.Holmes@uth.tmc.edu.
authors.forename: Holly
authors.initials: H
authors.lastname: Holmes
authors.affiliation: Faculty of Pharmacy and School of Public Health, The University of Sydney, Sydney, Australia. sallie.pearson@sydney.edu.au.
authors.forename: Sallie
authors.initials: S
authors.lastname: Pearson
authors.affiliation: School of Pharmacy, Queen's University, Belfast, UK. c.hughes@qub.ac.uk.
authors.forename: Carmel
authors.initials: C
authors.lastname: Hughes
authors.affiliation: St Benedict's Hospice and Centre for Specialist Palliative Care, Ryhope, Sunderland, UK. inga.andrew@stft.nhs.uk.
authors.forename: Inga
authors.initials: I
authors.lastname: Andrew
authors.affiliation: St Benedict's Hospice and Centre for Specialist Palliative Care, Ryhope, Sunderland, UK. Lisa.Baker@stft.nhs.uk.
authors.forename: Lisa
authors.initials: L
authors.lastname: Baker
authors.affiliation: Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Thornaby, Stockton-on-Tees, TS17 6BH, UK. a.k.husband@durham.ac.uk.
authors.forename: Andy
authors.initials: A
authors.lastname: Husband
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010361:Patients / Q000523:psychology*; D019338:Polypharmacy; D036301:Qualitative Research; D011788:Quality of Life
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