imageFutile meds in hospice:

  • We need not to contineu FUTILE MEDS
  • A 2010 survey of more than 10,000 physicians in the United States found respondents divided on the issue of recommending or giving “life-sustaining therapy when [they] judged that it was futile”, with 23.6% saying they would do so, 37% saying they would not, and 39.4% selecting “It depends”
  • Withholding or withdrawing  futile meds or medical care does not  speed  nor encourage the onset of death.
  • Hippocratic oath : “under no circumstances will we prescribe a deadly drug nor give advice which may cause death”. Now I add ” do not give any futile treatments“.
  • FUTILE MEDS:  are the meds with 
  1. No further benefits using the meds, but may prolong death / dying process,
  2. Desired outcome can not be met,
  3. Anything < 5 % chances of success would be futile,
  4. Poor quality of life to continue the treatment,
  5. No useful purpose
  6. Medications completely in effective

 

List of  meds you can avoid :

1. Aspirin : risk is more than benefit.

2. Docusate (Colace): Lack of proven efficacy / risks / benefits.  Side effects of it. Solution taste very bad for 2-3 hrs after ingestion.

3.  Meds for Alzheimer’s: are not effective in terminal patients. Sometimes we continue the meds if they are helping with the behavior.

4.  Statins: No good evidence that statins being effective in terminal patients. PROVE IT (study)– excluded patients who were likely to die within 2 years. No evidence that stopping statins in patients with chronic cardiac disease increases mortality except higher LDLs. Side effects:  Myalgia, arthralgia, drug-drug interactions, GI problems, etc

5. Multi-Vitamins:  are not proven to be effective. Side effects: unpleasant taste, indigestion, constipation, nausea, expense.

6. Beer’s criteria : archives of internal medicine: futile meds in nursing home population: 13 specialist, 30 criterias:  sedative-hypnotics, antidepressants, antipsychotics, antihypertensives, nonsteroidal anti-inflammatory agents, oral hypoglycemics, analgesics, dementia treatments, platelet inhibitors, H2 blockers, antibiotics, decongestants, iron supplements, muscle relaxants, GI antispasmodics, and antiemetics.

7.  Doctors are able to reduce unneccesory meds by 7.3 to 7.5%

8. NEW ORLEANS – Futile / duplicate medications remain a largest burden among patients at the end of life, according to a blinded, prospective cohort study of 397 consecutive hospice patients. At some point in their end of life care, 39% of patients received futile medications such as statins, and 19% received duplicate medications.

9. Vitamins and minerals including calcium, iron, and fish oil supplements made up the bulk of futile medications (67%), followed by statins (21%), and other medications (12%) including allopurinol (Zyloprim and generics), Imodium, megestrol acetate (Megace), Metamucil, epoetin alfa (Epogen), alendronate sodium (Fosamax), cholestyramine (Questran), and silodosin (Rapaflo), Mr. Munshi reported.

10. Questionable medications were anticoagulants/antiplatelets (36%), Alzheimer’s medications (18%), electrolytes (14%), appetite stimulants (9%), and other (23%) including acetaminophen, ranitidine (Zantac), methylphenidate (Ritalin), amphetamine and dextroamphetamine (Adderall), cetirizine (Zyrtec), Sudafed, etc.

11. Ventilator : can be discontinue

12. CPR: not needed

13. Food, & fluids can be stopped.

14.  About  51 articles examined in detail, three studies relating to cancer have been evaluated. In these retrospective and cross-sectional studies, the incidence of PIMs (potentially inappropriate meds) was shown in approximately 20 % of patients, although the studies were inconsistent.

15.  Assess the patient with emphasis on GOALS OF CARE. Balance with perspective from everybody involved including primary care, oncologist and other colleague on your team.

16, Surgical intervention in a patient who is terminal is futile.

17. Keeping a brain dead patient on ventilator is futile therapy.

18. No therapies are needed if there is no hope for cure, nor any benefit nor any hope for improvement.

19. Withholding / withdrawing futile therapies neither encourage nor speed up the natural dying process.

20. Always remember ” Do good, Do no harm”

**If you come across some meds you believe are futile, then do not hesitate to drop us a note.

Thanks

Kazmi, MD