Factors to consider when withdrawing medications
| FACTORS | EXPLANATION |
|---|---|
| Dialogue | There needs to be frequent dialogue on goals of care, as goals might change |
| Framework for care | We need to create a framework for care to aid in clinical decision making in the pharmacologic management of comorbid medical conditions |
| Metabolism of drugs and the pathophysiology of death | We need to consider the net effect of a drug such as a BP medication as death approaches, given the altered nutritional and hydration state of a patient and the risks of polypharmacy. The net effect of the medication might be greater (ie, marked drops in BP resulting in substantial morbidity) |
| Measure of benefit vs burden, or the NNT | In the palliative care setting, the NNT for a comorbidity will increase as the prognosis or life expectancy decreases and therefore the benefit decreases |
| Time until benefit | Is life expectancy long enough to benefit from a particular medication? Medications for primary or secondary prevention often have a time to benefit of years before the desired outcome is achieved. Stopping or not initiating medication might be in the best interest of a patient |
| Prognosis or natural history | We need to consider prognosis or natural history of the medical comorbidities and the life-threatening illness |
| Medical intervention | What is the intention of medical intervention? Primary, secondary, or tertiary prevention? |
| Polypharmacy and consequent adverse effects | We must have an understanding of the potential for polypharmacy and the consequent adverse effects |
| Other factors | We need to consider the emotional, psychological, and cultural effects of withdrawing drugs |