Methodological Challenges for Epidemiologic Studies of Deprescribing at the End of Life.

Purpose of Review: To describe approaches to measuring deprescribing and associated outcomes in studies of patients approaching end of life (EOL).
Recent Findings: We reviewed studies published through 2020 that evaluated deprescribing in patients with limited life expectancy and approaching EOL. Deprescribing includes reducing the number of medications, decreasing medication dose(s), and eliminating potentially inappropriate medications. Tools such as STOPPFrail, OncPal, and the Unnecessary Drug Use Measure can facilitate deprescribing. Outcome measures vary and selection of measures should align with the operationalized deprescribing definition used by study investigators.
Summary: EOL deprescribing considerations include medication appropriateness in the context of patient goals for care, expected benefit from medication given life expectancy, and heightened potential for medication-related harm as death nears. Additional data are needed on how EOL deprescribing impacts patient quality of life, caregiver burden, and out-of-pocket medication-related costs to patients and caregivers. Investigators should design deprescribing studies with this information in mind.
Competing Interests: Conflict of Interest Dr. Tjia reports grants from National Institute of Aging during the conduct of the study. Dr. Mack reports grants from the National Institutes of Health and the National Center for Advancing Translational Sciences during the conduct of the study. Dr. Lund reports other financial activities from GlaxoSmithKline outside the submitted work. Dr. McDermott reports grants from the National Heart Lung and Blood Institute outside the submitted work. Dr. Yuan reports grants from the National Institute on Aging outside the submitted work. Ms. Chen, Dr. Mbrah, and Mr. Osundolire report no conflict of interest.