Background In end-of-life care, symptoms of\ndiscomfort are mainly managed by drug therapy, the\nguidelines for which are mainly based on expert opinions.\nA few papers have inventoried drug prescriptions in palliative\ncare settings, but none has reported the frequency of\nuse in combination with doses and route of administration.\nObjective To describe doses and routes of administration of\nthe most frequently used drugs at admission and at day of\ndeath. Setting Palliative care centre in the Netherlands.\nMethod In this retrospective cohort study, prescription data\nof deceased patients were extracted from the electronic\nmedical records. Main outcome measure Doses, frequency\nand route of administration of prescribed drugs Results All\nregular medication prescriptions of 208 patients, 89 % of\nwhom had advanced cancer, were reviewed. The three\nmost prescribed drugs were morphine, midazolam and\nhaloperidol, to 21, 11 and 23 % of patients at admission,\nrespectively. At the day of death these percentages had\nincreased to 87, 58 and 50 %, respectively. Doses of these\nthree drugs at the day of death were statistically significantly\nhigher than at admission. The oral route of administration\nwas used in 89 % of patients at admission\nversus subcutaneous in 94 % at the day of death. Conclusions\nNearing the end of life, patients in this palliative care\ncentre receive discomfort-relieving drugs mainly via the\nsubcutaneous route. However, most of these drugs are\nunlicensed for this specific application and guidelines are\nbased on low level of evidence. Thus, there is every reason\nfor more clinical research on drug use in palliative care.
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