Prescribing Patterns of End-of-Life Medication for Compassionate Discharge: A Retrospective Observational Cohort Study

Objective In Singapore, where home is often the preferred place of death, compassionate discharge enables acutely deteriorating patients in hospital to die in their location of choice. Anticipatory prescribing ensures medication access at home for timely relief of distressing symptoms. Without standardized guidelines, however, prescribing patterns remain unclear. We investigate medication use in this unique setting by evaluating types and dosages of drugs prescribed for adult patients on terminal care at home. Methods A retrospective observational cohort study was conducted on home hospice patients. One hundred twenty-nine patients compassionately discharged from tertiary hospitals to a home hospice service between April and December 2023 who died within 2 weeks of returning home were included. All medications prescribed were reviewed, with names and dosages extracted and categorized by pharmacological action. Results A median of one medication was prescribed per patient. Cancer patients required significantly more medications compared to non-cancer patients ( P = .001). The most prescribed drug classes were opioids, antisecretory drugs and sedatives (89.9%, 86.8%, and 86.0% of the study population, respectively). Medication most frequently prescribed included fentanyl, hyoscine butylbromide, and haloperidol (81.4%, 76.0%, and 71.3% of the study population, respectively). Patients were prescribed a median of 2 classes of anticipatory medications at compassionate discharge, increasing to 4 by the time of death. This difference was statistically significant ( P < .001). Conclusions Cancer patients exhibited higher overall drug burden, but this may require further evaluation for confounders. Further studies evaluating the usage of anticipatory medications at the end of life can further refine anticipatory prescribing practices to reduce drug wastage.