Aims: Polypharmacy is increasingly common and so is the risk of associated adverse clinical outcomes. Decreasing the use of potentially inappropriate medications at the end-of-life may be facilitated through deprescribing tools, although their effectiveness among individuals with life-limiting illnesses remains unclear. The study aims were to examine the psychometric properties of deprescribing tools and the associated clinical outcomes for adults with life-limiting illnesses.
Methods: This was a systematic review registered with PROSPERO (CRD420251018366). MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Cochrane library and grey literature were searched from 2000. Eligible studies described development and application of deprescribing tools for adults at the end-of-life. Risk of bias assessment used the ROBINS-I V2 tool.
Results: Of 4108 papers, 34 studies met inclusion criteria. Eighteen deprescribing tools were identified. The Delphi method was the most frequently used approach for item inclusion. Definition of ‘limited life expectancy’ varied. Thirteen studies assessed reliability and/or validity; 8 demonstrated reduction in the number of medicines used. Clinical outcomes comparing deprescribing with control interventions were mostly non-significant, although there was supportive evidence for delayed mortality, reduced referral to acute care and lower costs. Risk of bias was moderate to high.
Conclusion: A range of deprescribing tools exist for patients with limited life expectancy. Deprescribing tools may reduce medication burden and improve selected outcomes in palliative populations, including mortality, acute care referral and medication costs. High risk of bias associated with these results limits strong conclusions, regarding the validity and clinical impact of deprescribing tools at the end-of-life.