[Discontinuation of potentially inappropriate medications at the end of life: perspectives from patients, their relatives, and physicians]

OBJECTIVE: To obtain insight into the perspectives of patients, relatives and physicians towards potentially inappropriate medications (PIMs) at the end of life. DESIGN: Qualitative interview study. METHOD: An analysis of in-depth interviews with 17 patients who were diagnosed as having a life expectancy of less than three months, 12 patient relatives, and 20 medical specialists and 12 general practitioners who cared for them. For analysis we applied the constant comparative method, which forms part of the grounded theory approach. RESULTS: Patients and their relatives are prepared to discontinue PIMs. Still, some patients reported that stopping might give them the feeling that their attending physician has already thrown in the towel. Physicians mentioned several reasons for not ceasing PIMs: cessation not considered, low priority, and unknown consequences of discontinuation. Some physicians were concerned that discussing the discontinuation of PIMs with patients could make patients acutely aware of the approach of death, and give patients the impression that they are receiving inferior medical care. If physicians communicate with patients the possibility of discontinuing medications, they seem to emphasize the clinical futility of continuing PIMs in light of the patient's limited life expectancy. CONCLUSION: Patients with a limited life expectancy and their relatives may be open to discontinue PIMs; however, in reality this happens rarely. When a physician is of the opinion that it would be of benefit to discontinue certain medications, then the advantages of cessation should be highlighted more in discussions with the patient.