The health care team, the patient and the family together need to consider several factors before making any change in medications. All these questions need to be answered:
What are the patient’s or family’s goals for care?
This may be the most important question. The goals must be realistic and achievable. For example, it may not be realistic to give medications to increase appetite when the patient isn’t hungry and eating won’t change the course of the illness.
What is the patient’s condition?
For example, often oral medications are stopped if the patient has trouble swallowing or is no longer alert.
What is the benefit of the medication?
In late stages of an illness, when maintaining comfort is a goal, it’s common to stop any medications that are not essential for comfort.
What will the patient feel if the medication is stopped or decreased?
If the person is still feeling pain, then medications that relieve pain are still helpful. If the person can’t swallow, then medications can be administered some other way.
There usually comes a time when medications that are not directly needed for comfort are discontinued. This happens when a person is no longer able to swallow or becomes unconscious. At this point discussions with the health care team will include which medications to continue and how those medications will be administered. Often medications to treat symptoms such as pain can be administered in other ways.