• Maike S van der Waal, Saskia Ccm Teunissen, Allegonda G Uyttewaal, Cathelijne Verboeket-Crul, Hanneke Smits-Pelser, Eric Ct Geijteman, and Matthew P Grant.
• Center of Expertise in Palliative Care Utrecht, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands.
• Palliat Med. 2024 Sep 1; 38 (8): 884892884-892.

BackgroundFor people with limited lifetime expectancy, the benefit of many medications may be outweighed by their potential harms. Despite the relevance of reducing unnecessary medication use, deprescribing is poorly enacted in primary care practice.AimThis study aims to describe factors, as identified by primary care professionals and patients, that influence deprescribing in the last phase of life.DesignSemi-structured interviews were conducted and analysed using a thematic approach.Setting/ParticipantsThis study was performed in primary care settings, including general practices, hospices and community care teams in The Netherlands. Purposefully identified primary care professionals (general practitioners, pharmacists, nurses) and patients with limited lifetime expectancy due to advanced chronic illness or cancer and their caretakers were interviewed.ResultsThree themes emerged detailing factors influencing deprescribing in the last phase of life in primary care: (1) non-maleficence, the wish to avoid additional psychological or physical distress; (2) reactive care, the lack of priority and awareness of eligible patients; and (3) discontinuity of care within primary care and between primary care and specialty care.ConclusionsDeprescribing is an incremental process, complicated by the unpredictability of life expectancy and attitudes of patients and health care professionals that associate continued medication use with clinical stability. Opportunities to facilitate the deprescribing process and its acceptance include the routinely systematic identification of patients with limited life expectancy and potentially inappropriate medications, and normalisation of deprescribing as component of regular primary care, occurring for all patients and continuing into end-of-life care.

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