Key points to consider in the pharmacological management of end-of-life (terminal) symptoms include:
- Confirm the patient and/or their Substitute Decision Maker (SDM) are aware that the patient is dying and support the use of medicines to manage end-of-life (terminal) symptoms.
- Prescribe medicines based on careful assessment of the dying patient's condition and symptoms.
- Regularly reassess treatment so the doses are proportionate to the severity of symptoms.
- Cease any medications that have minimal therapeutic benefit in the terminal phase of life.
- Consider the burden associated with how medicines are given, minimising the potential for side effects.
- Consider administering medicines via the subcutaneous route - the least invasive and most reliable route in the dying.
- Write up PRN orders for intermittent symptoms and to cover possible breakthrough events for persistent symptoms.
- Ensure that medicines are easily accessible when needed by writing up the medicines in advance (see Anticipatory prescribing).
- Identify the cause of problems and then manage in the context of the patient's preferences: remembering some things are irreversible and are a part of the dying process.
- The medicines listed throughout this app are in line with those endorsed by Caring at Home and the Australian and New Zealand Society of Palliative Medicine (ANZSPM) within the Community End-of-Life Medicines List (168kb pdf).
- The Community Palliative Care Medication List is an expansion on those listed within the PA Toolkit. Table 2 Palliative Care in Residential Aged Care Facilities: Medications Commonly Used to Manage Symptoms at End of Life can be found within the Guide to the Pharmacological Management of End of Life (Terminal) Symptoms in Residential Aged Care Residents: A Resource for General Practitioners (260kb pdf). Based on publication date (2013) use this resource with caution and reference to more current resources such as the Therapeutic Guidelines. (subscription required).
Prescribing guidance for end-of life symptoms
Page updated 19 July 2018