In hospice care, patient comfort and well-being are paramount. End-of-life patients need medications to manage symptoms and improve their quality of life. Innovations in pharmaceuticals and palliative care have led to hospice-specific therapies. In this article, we’ll discuss hospice medication innovations and how they improve end-of-life care.
Because Medicare only recently began requiring hospice agencies to report prescriptions, hospice-related prescribing of these and other drugs has been studied less. According to the study, new research and guidelines are needed to give hospice patients the best care.
While sedated hospice patients may be appropriate for advanced cancer patients, hospices increasingly serve dementia and other non-terminal patients. In those cases, patients and families may avoid sedation to stay alert and social.
Evolution of Hospice Medications
Historically, hospice medicine focused on curative treatments. As palliative care has evolved, symptom management and holistic support for patients and their families have become priorities. Medication now dominates pain relief, symptom management, and comfort.
Common Hospice Medications
Medication is essential to hospice. Learn about hospice medications if you or a loved one is considering or receiving them. This article aims to do that without muddled medical terminology. Many readers print this article for their next medical appointment.
Hospice medications list:
Below is an alphabetical list of common hospice medications, their uses, and other information:
Acetaminophen
Acetaminophen is the most commonly prescribed hospice medication, according to an NIH study. Tylenol reduces fever and pain. It relieves minor headaches, backaches, toothache, colds, and arthritis pain. Although rare, serious side effects can include nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, or jaundice. Warfarin (Coumadin), Isoniazid (Laniazid, Nydrazid), Diflunisal (Dolobid), Carbamazepine (Tegretol), phenobarbital (Luminal), and phenytoin may interact.
Anticholinergics
Anticholinergic and antispasmodic drugs control muscle contraction and relaxation. This includes Benadryl, a popular drug. Parkinson’s, COPD, asthma, overactive bladder, muscle spasms, breathing problems, diarrhea, gastrointestinal cramps, movement disorders, and others may require anticholinergics. Anticholinergic and antispasmodic drugs can cause blurred vision, confusion, constipation, decreased sweat or urine production, delirium, dry eyes, dry mouth, and memory loss. These drugs can worsen Alzheimer’s, enlarged prostate, glaucoma, myasthenia gravis, and urinary bladder neck obstruction. Certain antidepressants, antidiarrheals, antiemetics, antipsychotics, antispasmodics, histamine 1-receptor blockers (H1RA), motion-sickness, OAB, and Parkinson’s medications should not be taken with anticholinergics.
Antidepressant medications
Antidepressants were 11th among the 20 most commonly prescribed medications for hospice patients with cancer, dementia, and lung disease, according to the NIH study. Antidepressants, among other conditions, treat depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, dysthymia, or mild chronic depression. SSRIs and SNRIs are the most commonly prescribed antidepressants. Prozac and Zoloft are popular antidepressants. Anxiety, constipation, dizziness, dry mouth, headache, hypoglycemia, insomnia, low sodium, nausea, rash, sedation, sexual dysfunction, suicidal thoughts, sweating, tremors, and weight loss may occur. Antidepressants should not be mixed with alcohol. Anti-epileptics, benzodiazepines, Buspirone, Lithium, MAOIs, Metoprolol/Propranolol (blood pressure), NSAIDs like aspirin, Perhexiline, Selegiline, Sibutramine, St. John’s Wart, Sumatriptan, Tramadol, and Warfarin can also cause side effects.
Anxiolytics
As their name implies, these drugs treat anxiety. They can also treat alcohol withdrawal, depression, insomnia, itching, nausea, panic disorder, seizures, and vomiting. The IAHPC calls anxiolytics “essential medicines in palliative care.” Blurred vision, confusion, constipation, diarrhea, drowsiness, dry mouth, headache, increased heart rate, sedation, sexual dysfunction, stomach upset, suicidal thoughts, and weight gain may occur. Anxiolytics should not be taken with alcohol, Buspirone, Carbamazepine, hydroxyzine, MAOIs, pioglitazone (Actos), rosiglitazone (Avandia), SNRIs, or SSRI.
Atropine Drops
Instead of injections, hospice patients use atropine eye drops to reduce mucus and saliva. IBS, Parkinson’s disease, peptic ulcers, spastic bladder, colitis, diverticulitis, excessive stomach and acid production, gastrointestinal spasms, and certain heart disorders are treated with atropine. The NIH-published study ranked atropine fourth among commonly prescribed drugs. Blurred vision, constipation, dry mouth, palpitations, tachycardia, and urinary issues are drug side effects. Use belladonna, bladder or urinary medications, bronchodilators like Spiriva, digitalis, Dramamine, and IBS medications with caution.
Fentanyl
Hospice medications like Fentanyl relieve severe, ongoing pain like cancer pain. Long-acting Fentanyl transdermal patches are often prescribed to chronic pain patients, especially those who have trouble swallowing. Dissolving, under-the-tongue tablets are available for this medication. Fentanyl ranked 18th in the NIH study. Confusion, decreased urge to breathe, difficulty breathing or swallowing, extreme drowsiness, fainting, and slow or shallow breathing are serious side effects. Agitation, heartbeat changes, diarrhea, dizziness, fever, hives/rash/itching, hallucinations, loss of appetite, coordination, muscle stiffness or twitching, nausea, seizures, shivering, sweating, vomiting, and weakness are other serious side effects. Fentanyl may interact with painkillers and naltrexone. Many hospices, including Crossroads, do not prescribe Fentanyl because it is expensive and there are better painkillers.
New Therapies and Approaches in Hospice Care to Enhance Quality of Life
Let’s examine these innovations and how they improve patient life.
1. Palliative Pharmacology
Hospice has long prioritized pain management. New developments are entering pharmacology. These innovations reduce side effects and provide relief.
Example: opioid rotation strategies. These methods reduce pain. Novel formulations like transdermal patches and sublingual tablets are also beneficial. Patients who struggle with oral medications can try these formulations.
2. Psychosocial Support
End-of-life care requires emotional and psychological support. Hospice programs have added psychosocial support. Counseling, support groups, and spiritual care are examples.
So each person and their family can meet their unique needs. These interventions reduce stress and promote acceptance and serenity during this difficult time.
3. Symptom Management Innovations
Hospice treats nausea, dyspnea, and fatigue. The latest symptom management innovations include targeted drug therapies, non-pharmacological interventions, and medical devices.
For example, less-sedative antiemetic drugs. It has improved nausea and vomiting treatment and quality of life.
4. Telehospice or Remote Monitoring
Telehospice is another technology revolutionizing healthcare. It uses mobile apps, video conferencing, and wearables to deliver healthcare remotely. The global telemedicine market will reach $130 billion by 2025.
The World Health Organization defines telemedicine as “healing from a distance.”
This technology is most useful in rural areas where doctors must travel far to see patients or where hospice care is unavailable.
Telehospice benefits include:
Benefits of Telehospice for Patients
Telehopice’s patient offers include:
- Cost-effective Medical Care: Telehospice apps offer low-cost online doctor consultations, which are especially useful for people with limited insurance.
- Saves Time: Telehospice consultations are shorter than in-person hospice care. The patient and doctor are more likely to discuss the medical issue and get results.
- Easy Access to Physicians: Some websites offer 24/7 physician access. Patients now have easier access to out-of-state specialists.
5. Integrative Therapies
This holistic approach to treating physical, emotional, and spiritual needs has made integrative therapies popular in hospices. Massage, acupuncture, and art & music therapy reduce pain, anxiety, and depression. These therapies also relax and improve well-being.
Addressing Ethical and Regulatory Considerations:
As with any medical intervention, hospice medication use raises ethical and regulatory concerns. End-of-life decisions must balance patient autonomy with beneficence and nonmaleficence. Medication access must be fair to all patients, regardless of socioeconomic status, who receive care. Hospice medications must be regulated to ensure safety and efficacy while navigating FDA approvals and off-label drug use.
Conclusion
In conclusion, advances in hospice medication represent a groundbreaking shift toward patient comfort and quality of life in end-of-life care. Hospice medication management is changing rapidly, from opioid rotation strategies and targeted drug formulations to psychosocial support services and telehospice technology. To ensure equitable access to care and patient autonomy, ethical and regulatory considerations must be navigated alongside these innovations. We can improve hospice care by adopting these new therapies and methods to give patients and their families dignity, comfort, and support.
Isaac is a highly accomplished healthcare professional with over 13 years of experience in healthcare administration, medical billing and coding, and compliance. He holds several AAPC specialty certifications and has a bachelor’s degree in Health Administration. He worked previously at a large multi-physician family care and occupational health practice with two locations in northwestern PA and now works for Medcare MSO in the ICD-10 Editorial department to write articles about medical billing services. He enjoys sharing his knowledge and experience as a certified PMCC instructor. He has authored many articles for healthcare publications and has been a featured speaker at workshops and coding conferences across the country.
Medcare MSO is a medical billing services provider located in New Mexico that healthcare organizations can engage to improve their revenue cycle management. The leading responsibility of Medcare MSO is to provide problem-solving solutions through skilled and professional medical billers and coders. These services include Hospice medical billing services, cardiology medical billing, physician medical billing, and many others.
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