Goal-Concordant Prescribing and Deprescribing

Goal-concordant prescribing is the process of medication withdrawal and dose reduction, guided by the goals of care of the patient and supervised by a healthcare professional, with the goal of managing polypharmacy and improving outcomes. (Tjia JPSM 2021) 

Over two thirds of patients in hospice take 9 or more daily prescription medications. Typically, as their disease progresses, they’re prescribed even more meds to manage symptoms. At the same time, they have progressively declining organ function that increases their risk of drug-related harm. In addition to the impact on patients, this creates stress and confusion for family caregivers who are responsible for medication management and administration at home. 

Our Projects

Goal-Concordant Prescribing In Home Hospice

For this program, we worked with family caregivers and clinicians in hospice organizations in Massachusetts and Utah to standardize an approach to medication management for patients in hospice, with their continuously changing needs and goals. We developed a 3-step “Review, Align and Simplify” approach, which included a curriculum and educational materials. The program was refined with input from participants, and then tested in a pilot clinical trial. 

Initial feedback from hospice staff was that the “Review, Align, and Simplify” approach is helpful and a great resource on how to start conversations regarding medications. As a result the training has been incorporated into the onboarding training of a local hospice program and is being developed for wider dissemination.

“...the conversation guide is a helpful tool for the hospice case manager.  Often, deprescribing can be difficult for the patient and their families to understand… I like how this tool uses the education for medication use and aligns it with the goals of care.”

-- study participant

Building a Replicable Training Tool for Clinicians

Using a clinician-guided, patient-centric approach

The objective for this program is to replicate and scale our novel “Review, Align, and Simplify” approach to help front-line hospice clinicians communicate with family caregivers  For this project, we’re combining our expertise in goal-concordant prescribing, with the expertise of Ariadne Labs, the center for health systems innovation at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. With them, we’ve used human-centered design principles to create a scalable program that can be implemented by home hospice providers and hospice pharmacy benefit managers nationwide.

We are currently testing to evaluate the program’s impact on medication use, costs, and care outcomes.