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Home-based palliative care (HBPC) improves quality of life by addressing distressing physical, psychosocial, and spiritual symptoms. However, symptom and medication burdens remain prevalent challenges. This study sought to characterize symptom prevalence and severity, the associated medication burden, and determine opportunities for deprescribing in the setting of HBPC. Patients referred to a home-based palliative care practice over a two-year period were included; 109 patients met inclusion criteria. Mean age was 78 years (± 11.8), and average Charlson Comorbidity Index (CCI) was 6.4 (± 2.7). The mean Palliative Performance Scale (PPS) score was 53.1, indicating moderate functional impairment. Patients reported a mean of 4.1 symptoms, with pain, depression, and lack of appetite being most common. Mean total number of medications was 11.1 (SD = 5.4), with 24% taking 15 or more medications. Average medication complexity score was 31.3 (± 16.9). Sub-optimally managed symptoms were identified in several domains, especially depression, pain, tiredness, and anxiety. Adverse Drug Reactions (ADRs) were documented in 49.5% of patient records. Opportunities for deprescribing were identified in 38.5%. Patients receiving HBPC experience significant symptom and medication burden. Optimization of symptom management and medication regimens, including targeted deprescribing, may reduce medication burden and improve outcomes.
Pawasauskas et al. (Mon,) studied this question.