📋 Key Information Summary
- Medication rationalisation is the systematic review and reduction of medicines that no longer align with a patient's goals of care, prognosis, or treatment priorities in the palliative setting.
- As goals shift from disease modification to comfort, non-beneficial preventive or disease-modifying drugs (e.g. statins, bisphosphonates, antihypertensives, oral hypoglycaemics) should be reviewed for deprescribing, while symptom-control medicines (analgesics, antiemetics, anxiolytics) continue or escalate.
- A structured deprescribing process uses five steps: (1) ascertain all medications, (2) identify potentially inappropriate medicines, (3) assess whether each drug can be ceased, (4) prioritise withdrawal, (5) implement a monitored plan.
- Preventive medicines with a long time-to-benefit (≥12 months) — statins, antihypertensives for primary prevention, osteoporosis prophylaxis, aspirin for primary cardiovascular prevention — are the strongest candidates for cessation in advanced illness.
- Withdrawal risks are real: abrupt cessation of corticosteroids, benzodiazepines, opioids, beta-blockers, clonidine, and gabapentinoids can cause rebound syndromes, seizures, autonomic instability, or severe distress.
- Always taper corticosteroids (risk of adrenal crisis), benzodiazepines (risk of seizures), opioids (risk of withdrawal symptoms and rebound pain), beta-blockers (risk of rebound tachycardia and angina), and gabapentinoids (risk of seizures).
- Proton-pump inhibitors (PPIs) prescribed for gastroprotection alongside ceased NSAIDs or aspirin can usually be stopped; review indications and step down or cease.
- Diabetes medicines — particularly insulin and sulfonylureas — carry hypoglycaemia risk; relax HbA1c targets to 8.5% or consider cessation of glucose-lowering agents in the last weeks of life.
- Anticoagulants and antiplatelets require individualised risk–benefit assessment; consider bleeding risk, fall risk, and likelihood of thromboembolic event before continuing or ceasing.
- Communication with family is essential — explain that stopping a medicine is an active clinical decision aligned with comfort goals, not "giving up." Use clear, compassionate language and document discussions.
- Involve a pharmacist (ideally a credentialed palliative care pharmacist) in the medication review; polypharmacy is present in 40–60% of Australian palliative care patients.
- Aboriginal and Torres Strait Islander peoples may face additional barriers including cultural views on medication, limited access to specialist palliative care, and distrust of mainstream health systems — engage Aboriginal health workers and culturally safe communication.
Introduction & Australian Epidemiology
Medication rationalisation is the systematic process of reviewing a patient's medication regimen in the context of their current health status, prognosis, and goals of care, and then reducing or ceasing medicines that are no longer beneficial, are causing harm, or are contributing to treatment burden. In palliative care, this process — often termed deprescribing — becomes a core clinical responsibility as the balance between potential benefit and harm shifts with advancing disease.
Polypharmacy is highly prevalent among Australians receiving palliative care. Studies from Australian specialist palliative care services report that patients take a median of 8–12 regular medications at the time of referral, with up to 60% taking at least one medicine classified as potentially inappropriate in the context of their prognosis. The Palliative Care Outcomes Collaboration (PCOC) and the Australian Institute of Health and Welfare (AIHW) data confirm that medication burden is a significant contributor to patient distress, swallowing difficulties, and medication-related adverse events in the last months of life.
The Australian Commission on Safety and Quality in Health Care (ACSQHC) has identified medication safety in palliative care as a priority area. The National Safety and Quality Health Service (NSQHS) Standards, particularly Standard 4 (Medication Safety), require healthcare organisations to have processes for reviewing medicines at transitions of care — a principle that directly applies to entry into palliative care.
Key Australian data points include:
- Approximately 170,000 Australians die each year; the majority could benefit from some form of palliative care approach during their final year of life.
- The median number of medications in Australian residential aged care facilities (where many residents have palliative care needs) is 9.7 (AIHW 2023 data).
- Medication-related hospital admissions account for an estimated 2–3% of all admissions; a proportion of these are preventable through better medication review in the palliative trajectory.
- Australian studies show that statins, antihypertensives, PPIs, and oral hypoglycaemics are the most commonly continued potentially futile medications in advanced illness.
- Only 30–40% of patients referred to Australian palliative care services have had a formal medication review prior to referral (Palliative Care Pharmacy Network data).
This article provides a structured approach to medication rationalisation and deprescribing in the Australian palliative care context, with emphasis on evidence-based principles, withdrawal risk management, specific drug classes, and family communication.
Deprescribing Principles
Deprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm or is no longer of benefit. The goal is to reduce medication burden and harm while maintaining or improving quality of life. In palliative care, deprescribing must be distinguished from therapeutic nihilism — it is an active, deliberate clinical intervention guided by evidence, prognosis, and patient preferences.
The Five-Step Deprescribing Framework
1
Ascertain All Medications
Compile a complete medication list including prescription medicines, over-the-counter products, complementary medicines, and supplements. Use the My Health Record, GP summaries (GP Management Plans), hospital discharge summaries, and community pharmacy dispensing records. Verify with the patient and carer.
2
Identify Potentially Inappropriate Medications
Cross-reference each medicine against the patient's current diagnoses, prognosis, goals of care, and functional status. Use screening tools such as the STOPPFrail criteria (specifically designed for frail older persons with limited life expectancy) or the Beers Criteria adapted for palliative populations. Ask: "Would I start this medicine today?"
3
Assess Whether Each Drug Can Be Ceased
For each identified medicine, evaluate: (a) time to benefit vs estimated prognosis, (b) current adverse-effect burden, (c) patient/carer wishes, (d) withdrawal risk if stopped abruptly, (e) whether the indication still applies, (f) any symbolic value to the patient (e.g. chemotherapy as hope). Classify each drug as: cease now, taper and cease, continue, or uncertain — discuss with team.
4
Prioritise and Plan
Cease the lowest-risk, lowest-benefit medicines first (e.g. statins, vitamins, supplements). Then address medicines requiring tapering. Do not attempt to stop everything at once — stagger changes over days to weeks. Document the plan in the patient's medication chart and clinical record. Communicate the plan to all members of the care team, including the GP, community pharmacy, and palliative care service.
5
Monitor and Review
After each change, monitor for: (a) withdrawal symptoms or rebound effects, (b) change in symptom burden, (c) patient/carer anxiety about stopping the medicine, (d) clinical deterioration that may be misattributed to stopping the drug. Reassess the entire medication list at every clinical review or change in condition. Document rationale for all decisions.
Principles Guiding Deprescribing Decisions
| Principle | Application in Palliative Care |
|---|---|
| Time to benefit | Medicines requiring months to years for benefit (statins, bisphosphonates, aspirin for primary prevention) offer little value when prognosis is weeks to months. |
| Harm vs benefit balance | Drug side effects (constipation from opioids is treated; constipation from iron is not) and drug interactions become relatively more harmful as the patient becomes frailer. |
| Patient goals | If the patient prioritises comfort and minimal interventions, medicines that require blood monitoring (warfarin), dietary restrictions (MAOIs), or multiple daily doses are targets for cessation. |
| Treatment burden | Tablets that are large, difficult to swallow, or cause nausea add to burden. Swallowing difficulties (dysphagia) in advanced disease mandate a review of all oral formulations. |
| Withdrawal risk | Never stop abruptly: corticosteroids, benzodiazepines, opioids, beta-blockers, clonidine, gabapentinoids, anticonvulsants. Always taper. |
| Symbolic value | Some medicines represent hope (e.g. maintenance chemotherapy). Tread carefully and involve the oncologist before ceasing. |
Never stop all medicines simultaneously. Stagger changes so that if a patient deteriorates, the cause can be identified. Cease one or two medicines at a time, review after 3–7 days, then proceed to the next group.
Preventive Drugs
Preventive (prophylactic) medications are among the most commonly continued medicines in advanced illness despite minimal expected benefit. These drugs are prescribed to reduce long-term risk of cardiovascular events, fractures, infections, or disease progression — benefits that take months to years to accrue and are irrelevant when life expectancy is limited.
Drug Classes: Cessation Recommendations
Statins
Atorvastatin (Lipitor®) · Rosuvastatin (Crestor®) · Simvastatin
Indication review
Primary prevention: cease if prognosis <12 months. Secondary prevention: consider cessation if prognosis <3 months or patient is symptomatic with side effects (myalgia, hepatotoxicity).
Time to benefit
1–5 years for cardiovascular event reduction
Withdrawal risk
No significant withdrawal syndrome. Can cease abruptly.
Key evidence
Randomised trial in palliative care (Kutner et al., JAMA 2015) showed no difference in QoL or survival when statins were discontinued.
PBS status
✔ PBS General Benefit
Antihypertensives
Perindopril (Coversyl®) · Amlodipine (Norvasc®) · Irbesartan (Avapro®)
Indication review
Primary prevention: consider cessation. Secondary prevention (e.g. post-MI, heart failure): cautious review — may still provide symptomatic benefit in heart failure. Symptomatic hypotension, postural dizziness, and falls are indications to reduce or stop.
Time to benefit
1–3 years for stroke/MI reduction
Withdrawal risk
Beta-blockers: REBOUND TACHYCARDIA, angina, hypertension — must taper over 1–2 weeks. Clonidine: rebound hypertension — taper over 1 week. ACE inhibitors, ARBs, CCBs: minimal withdrawal risk, can cease.
PBS status
✔ PBS General Benefit
Aspirin (primary prevention)
Cartia® · Astrix® · Disprin®
Indication review
Primary cardiovascular prevention: cease if prognosis <12 months. Secondary prevention: individualise — balance thrombotic risk vs bleeding risk. If patient is bedbound and at high fall risk, bleeding risk increases.
Withdrawal risk
No withdrawal syndrome. Can cease abruptly.
PBS status
✔ PBS General Benefit (low-dose aspirin generally OTC)
Bisphosphonates / Denosumab
Alendronate (Fosamax®) · Risedronate (Actonel®) · Denosumab (Prolia®)
Indication review
Primary prevention of osteoporotic fractures: cease. If used for bony metastases (zoledronic acid, denosumab) discuss with oncologist — may still provide skeletal-related event prevention and pain benefit.
Time to benefit
12–36 months for fracture risk reduction
Withdrawal risk
Denosumab: rapid bone loss and rebound vertebral fractures on cessation — if stopping, consider transition to bisphosphonate for 6–12 months if prognosis allows. Alendronate/risedronate: minimal withdrawal risk (residual effect persists).
PBS status
⚠ PBS Authority Required (denosumab) · ✔ PBS General Benefit (alendronate)
Oral Hypoglycaemics & Insulin
Metformin (Diabex®) · Gliclazide (Diamicron®) · Empagliflozin (Jardiance®)
Indication review
Relax HbA1c target to ≤8.5% (53 mmol/mol) or higher. Avoid hypoglycaemia at all costs — it causes distress, confusion, falls, and cardiac events. In the last 1–2 weeks of life, consider ceasing all glucose-lowering agents including insulin (except if symptomatic hyperglycaemia causes distress).
Specific agents
Metformin: cease if eGFR <30, risk of lactic acidosis with dehydration. Sulfonylureas: high hypoglycaemia risk — cease early. SGLT2 inhibitors: risk of euglycaemic DKA, volume depletion — cease. Insulin: if continuing, reduce doses by 25–50% when intake decreases; cease when patient is dying if no hyperglycaemic symptoms.
Withdrawal risk
No withdrawal syndrome, but monitor glucose. Rapidly rising glucose (>20 mmol/L) can cause osmotic symptoms — treat with low-dose insulin if symptomatic.
PBS status
✔ PBS General Benefit (metformin, gliclazide) · ⚠ PBS Authority Required (empagliflozin)
Proton-Pump Inhibitors
Pantoprazole (Somac®) · Esomeprazole (Nexium®) · Omeprazole (Losec®)
Indication review
If prescribed for gastroprotection with ceased NSAIDs or aspirin, the PPI can usually be ceased. If prescribed for active dyspepsia or GORD causing symptoms, continue. If prescribed "just in case" with no clear indication, cease.
Withdrawal risk
Rebound acid hypersecretion possible with long-term use — consider step-down to H2RA (ranitidine/famotidine) rather than abrupt cessation if symptomatic.
PBS status
✔ PBS General Benefit
Anticoagulants and Antiplatelets — Special Consideration
Anticoagulant and antiplatelet therapy requires individualised assessment rather than blanket cessation. Consider:
| Factor | Favouring Cessation | Favouring Continuation |
|---|---|---|
| Indication | Primary prevention, provoked VTE >3 months ago | Mechanical heart valve, recurrent VTE, atrial fibrillation with prior stroke |
| Bleeding risk | Active bleeding, thrombocytopenia, falls risk, hepatic failure | No active bleeding, stable platelets |
| Prognosis | Days to weeks — benefit of anticoagulation negligible | Months — ongoing thrombotic risk may be meaningful |
| Burden | INR monitoring (warfarin), injections (enoxaparin) | DOACs are low-burden (apixaban, rivaroxaban) |
DOACs (apixaban, rivaroxaban, dabigatran): If stopping, no taper required but ensure the patient understands the indication was for stroke/VTE prevention and that the risk is accepted in the context of goals of care. Do NOT stop warfarin or DOACs in patients with mechanical heart valves without specialist input.
Other Commonly Overlooked Medicines
- Iron supplements: Cessation recommended — constipation burden, no short-term benefit. Oral iron absorption is poor in inflammatory states.
- Folic acid: Unless treating documented deficiency causing symptomatic anaemia, can cease.
- Vitamin D / Calcium: Long time to benefit for fracture prevention; consider cessation.
- Thyroid replacement: Continue — abrupt cessation of levothyroxine can cause myxoedema within weeks and is distressing. Low burden to continue.
- Antibiotics for prophylaxis: Review ongoing prophylactic antibiotics (e.g. for UTI prevention); may still be appropriate if recurrent UTIs cause distress.
- Cholinesterase inhibitors (donepezil, rivastigmine): Time to benefit is uncertain; may cause GI side effects; consider cessation in advanced dementia.
- Antidepressants (SSRIs/SNRIs): Generally continue — abrupt cessation risks discontinuation syndrome. Taper if ceasing. May still provide anxiolytic benefit.
Withdrawal Risks
Abrupt cessation of certain drug classes can cause clinically significant withdrawal syndromes that cause patient distress, mimic disease progression, or create medical emergencies. These risks must be assessed before any deprescribing intervention and communicated clearly to the patient, family, and all members of the care team.
High-Risk Drug Classes Requiring Tapering
Severe Risk
Corticosteroids
Adrenal crisis (hypotension, collapse, hyponatraemia, hyperkalaemia) if ceased abruptly after >2–3 weeks of use. Also risk of disease flare (e.g. cerebral oedema in brain metastases, airway obstruction).
Taper: Reduce by 2.5–5 mg prednisolone equivalent every 3–7 days. If prognosis is days, may continue current dose rather than risk adrenal crisis.
Severe Risk
Benzodiazepines
Seizures, severe anxiety, tremor, psychosis, delirium, rebound insomnia. Risk highest with high doses, long duration, and short-acting agents (alprazolam, lorazepam).
Taper: Reduce dose by 10–25% every 1–2 weeks. For midazolam infusions in palliative care (subcutaneous), gradual reduction over 24–48 hours with monitoring. If prognosis is days and the patient is comfortable, continue rather than taper.
Severe Risk
Opioids
Withdrawal symptoms: tachycardia, sweating, lacrimation, piloerection, myalgia, abdominal cramping, diarrhoea, anxiety, restlessness. Severe distress in conscious patients. Rebound pain.
Taper: Reduce by 10–25% every 3–7 days. If in last days of life and sedated, subcutaneous opioid infusions may be continued for comfort and not tapered. Never abruptly cease high-dose opioids in an awake patient.
Moderate Risk
Beta-Blockers
Rebound tachycardia, hypertension, angina exacerbation, potential myocardial infarction. Risk greatest with propranolol (non-selective) and high-dose metoprolol.
Taper: Reduce by 25–50% every 3–7 days over 1–2 weeks. Monitor heart rate and symptoms.
Moderate Risk
Clonidine
Rebound hypertension (can be hypertensive crisis), tachycardia, headache, agitation, tremor.
Taper: Reduce by 50–75 mcg every 3–7 days. Monitor blood pressure daily during taper.
Moderate Risk
Gabapentinoids (Gabapentin, Pregabalin)
Seizures, anxiety, insomnia, diaphoresis, nausea. Risk with high doses and abrupt cessation.
Taper: Gabapentin — reduce by 100–300 mg every 3–7 days. Pregabalin — reduce by 25–50 mg every 3–7 days.
Moderate-Risk Drug Classes
| Drug Class | Withdrawal Risk | Taper Recommendation |
|---|---|---|
| Anticonvulsants (valproate, carbamazepine, levetiracetam) | Seizure recurrence, status epilepticus | Taper over 2–4 weeks. If the patient is in the last days of life and already obtunded, the risk of seizures is low — consider continuation via subcutaneous route if seizing. |
| Antidepressants (SSRIs, SNRIs, TCAs) | Discontinuation syndrome: dizziness, nausea, "brain zaps," irritability, anxiety, insomnia. Worst with paroxetine and venlafaxine. | Taper over 2–4 weeks. Fluoxetine has a long half-life and is the easiest to cease. |
| Antipsychotics (quetiapine, risperidone, haloperidol) | Rebound insomnia, nausea, psychosis (in schizophrenia). In palliative care often used for delirium/agitation — if the indication was delirium, may be able to cease as delirium resolves or the patient becomes obtunded. | Taper over 1–2 weeks if used long-term. If used short-term (<2 weeks) for acute symptom, can cease abruptly. |
| Alpha-blockers (tamsulosin, prazosin) | Rebound hypertension | Taper over 1 week if used for hypertension. For urinary symptoms (tamsulosin), can cease without taper. |
| Thyroid hormones (levothyroxine) | Myxoedema over weeks; depression, cognitive slowing, constipation, hypothermia | Generally CONTINUE — low burden, high consequence of stopping. If in last days of life, can cease (myxoedema takes weeks to develop). |
Critical safety point: Never stop corticosteroids, benzodiazepines, opioids, or beta-blockers abruptly in a conscious patient. These four drug classes account for the vast majority of clinically significant withdrawal events in palliative care. If in doubt, continue the current dose and seek specialist palliative care or clinical pharmacy advice before making changes.
Low-Risk / Safe to Cease Abruptly
- Statins (all agents)
- ACE inhibitors / ARBs (perindopril, irbesartan, ramipril)
- Calcium channel blockers (amlodipine, nifedipine)
- Diuretics (furosemide, hydrochlorothiazide) — monitor for fluid overload if continuing heart failure
- Aspirin (low-dose)
- Bisphosphonates (oral)
- Metformin
- Proton-pump inhibitors
- Iron, folic acid, vitamins, supplements
- Antibiotics (unless treating active infection)
Communication With Family
Deprescribing can be deeply confronting for patients and families. Medicines may symbolise control, hope, or active treatment. Stopping a medicine that has been taken for years may be perceived as "giving up" or withdrawing care. Skilled, empathetic communication is therefore as important as the clinical decision itself.
Key Communication Principles
1
Frame as Active Care, Not Withdrawal
"We are actively reviewing all of your medicines to make sure every medicine is still helping you and not causing unnecessary side effects. This is an important part of good care, especially as your health needs change."
2
Explain the Rationale Simply
"This medicine was prescribed to prevent a heart attack over many years. Since your goals have changed and we are focusing on keeping you comfortable, the medicine is no longer needed and may actually be causing side effects like muscle aches."
3
Distinguish Stopping Preventive Medicine from Stopping Symptom Treatment
"We will absolutely continue all the medicines that help with your pain, nausea, breathlessness, and anxiety. We are only stopping the ones that were for long-term prevention and aren't helping with how you feel day to day."
4
Acknowledge Emotions
"I understand this might feel like we are doing less, but I want you to know that reviewing medicines carefully is one of the most important things we can do. It is a sign of good care, not giving up."
5
Offer Reassurance and Reversibility
"If at any point you feel that we should restart a medicine, we can discuss that. Some medicines can be restarted, though for others the benefit would still be limited. Your comfort and peace of mind matter."
Common Family Concerns and Responses
| Family Concern | Suggested Response |
|---|---|
| "Are you stopping treatment because there's nothing more you can do?" | "We are not stopping treatment — we are changing the focus of treatment. All the medicines for comfort and symptom control will continue. We are stopping medicines that were for prevention over many years and are no longer appropriate." |
| "If you stop the blood pressure tablets, won't the blood pressure go dangerously high?" | "In the context of your [mother's/father's] current health, slightly higher blood pressure is not dangerous and won't cause a stroke in the short term. Stopping these tablets may actually make them feel better by reducing dizziness and tiredness." |
| "The diabetes tablets — won't the sugar go out of control?" | "We will monitor blood sugars gently. A slightly higher blood sugar is not dangerous in the short term and won't cause symptoms. What we want to avoid is the blood sugar going too LOW, which causes confusion and distress." |
| "Dad has been on this medicine for 20 years — shouldn't he keep taking it?" | "I understand why that feels important. A medicine that was right for 20 years may not be right now, because your father's health and goals have changed. We regularly review medicines — this is good medical practice." |
| "Will stopping these medicines make them die sooner?" | "The medicines we are stopping are for long-term prevention and have no effect on day-to-day comfort or how long your [loved one] will live in the short term. We would never stop a medicine that was helping them." |
Documentation: All deprescribing discussions with patients and families must be documented in the clinical record, including: who was present, what was explained, the patient/family response, and the agreed plan. This protects the clinical team and ensures continuity of care across settings (hospital, hospice, home).
Involving the Multidisciplinary Team
- General Practitioner: The GP is often the prescriber who knows the patient's medication history best. Communicate deprescribing plans and rationale clearly. Use the GP Management Plan (MBS item 721) and Team Care Arrangements (MBS item 723) as frameworks.
- Community Pharmacist: The pharmacist can assist with medication reviews (MBS-funded Home Medicines Review, item 900), identify drug interactions, and provide dose formulations (e.g. liquid alternatives when tablets are ceased).
- Palliative Care Pharmacist: Credentialed palliative care pharmacists (available in many Australian specialist palliative care services) can conduct comprehensive medication reviews using tools like the palliative-specific Medication Appropriateness Index.
- Specialist Physicians: Before ceasing medicines prescribed by specialists (e.g. oncology, cardiology), consult the prescribing specialist. They may have important contextual information or wish to discuss the change with the patient/family.
- Aboriginal Health Workers: For Aboriginal and Torres Strait Islander patients, involve Aboriginal Health Workers or Aboriginal Liaison Officers who can facilitate culturally safe communication about medication changes.
Aboriginal and Torres Strait Islander Health Considerations
Aboriginal and Torres Strait Islander Health
Medication rationalisation and deprescribing in Aboriginal and Torres Strait Islander peoples requires particular cultural sensitivity, an understanding of historical and ongoing distrust of mainstream health systems, and recognition of the unique barriers to palliative care access experienced by Indigenous Australians. The burden of polypharmacy is often compounded by limited access to clinical pharmacy services, specialist palliative care, and consistent GP care in remote and very remote communities.
📚 References
- 1. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–834. doi:10.1001/jamainternmed.2015.0324
- 2. Kutner JS, Blatchford PJ, Taylor DH Jr, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175(5):691–700. doi:10.1001/jamainternmed.2015.0249
- 3. Lavan AH, Gallagher P, Parsons C, O'Mahony D. STOPPFrail: Screening Tool of Older Persons' Prescriptions in Frail adults with limited life expectancy — a consensus-based tool. J Am Geriatr Soc. 2017;65(4):e46–e51. doi:10.1111/jgs.14716
- 4. Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Br J Clin Pharmacol. 2014;78(4):738–747. doi:10.1111/bcp.12386
- 5. Australian Commission on Safety and Quality in Health Care (ACSQHC). National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC; 2021.
- 6. Australian Institute of Health and Welfare (AIHW). Medication-related problems in residential aged care. Cat. no. AGE 100. Canberra: AIHW; 2023.
- 7. Palliative Care Australia. National Palliative Care Standards. 5th ed. Canberra: Palliative Care Australia; 2018.
- 8. Currow DC, Agar M, Sanderson C, Abernethy AP. Polypharmacy in patients with advanced life-limiting illness. Curr Opin Support Palliat Care. 2008;2(3):192–198. doi:10.1097/SPC.0b013e32830a4a68
- 9. Royal Australian College of General Practitioners (RACGP). Prescribing skills curriculum — Deprescribing. Melbourne: RACGP; 2022.
- 10. Holmes HM, Sachs GA, Shega JW, Hougham GW, Cox Hayley D, Dale W. Integrating palliative medicine into the care of persons with advanced dementia: identifying appropriate medication cessation. Drugs Aging. 2008;25(10):853–866. doi:10.2165/00002512-200825100-00004
- 11. Schenker Y, Park SY, Jeong K, et al. Associations between polypharmacy, symptom burden, and quality of life in patients with advanced, life-limiting illness. J Gen Intern Med. 2019;34(4):559–566. doi:10.1007/s11606-019-04836-8
- 12. Aboriginal and Torres Strait Islander Health Performance Framework. Medicines use. Canberra: Australian Institute of Health and Welfare; 2023.
- 13. Rowett D, Raven B, Currow DC. Palliative care pharmacy in Australia — a national overview. Aust Prescr. 2020;43(6):196–199. doi:10.18773/austprescr.2020.055
- 14. Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82(3):583–623. doi:10.1111/bcp.12975
- 15. Thompson W, Farrell B. Deprescribing: what is it and what does the evidence tell us? Can J Hosp Pharm. 2013;66(3):201–202. doi:10.4212/cjhp.v66i3.1261