Changes in Symptoms
During palliative care, a person’s symptoms and medication needs can change quickly. Being prepared for these changes helps keep the person comfortable and improves their quality of life.
- The person is still taking medications they no longer need, which may cause side effects or discomfort.
- Medications for common end-of-life symptoms (anticipatory medications) have not been prescribed.
- Staff may not notice when the person is in pain or distress, or they may not check if pain medication is working well, e.g. if the person has difficulty communicating verbally.
- The facility does not have the right medications or cannot get them quickly from a pharmacy.
- The person experiences pain or distress because their symptoms are not treated quickly.
- Teach staff about the goals of medication in palliative care, especially how to manage pain and symptoms well.
- Help staff recognise signs of pain and distress and use suitable communication aids and assessment tools. Ensure staff make sure they check if medications are working after they are given.
- Work with a prescribing health professional to review, reduce, or stop medications that are no longer needed to prevent side effects or harm.
- Follow a process and prompts to ensure anticipatory medications are prescribed in advance to manage symptoms when necessary.
- Make sure essential medications are easy to get by keeping them in stock or arranging a quick supply from a pharmacy.
- Check regularly if the person’s care and medication needs have changed, especially as they get closer to the end of life. Symptoms can change quickly at this time.
- Ask for advice from doctors, nurse practitioners, pharmacists, or other prescribers if there are any concerns about medications or care.
- Make sure staff understand how to give and manage end-of-life medications and check that they are doing this correctly.
- Get feedback from the person, their family, or their substitute decision-maker about how care is going and if anything needs to be improved.
The goal of medications in the palliative phase is to provide comfort and improve quality of life
Palliative care medications are not used to cure illness or ‘make someone better’. Instead, they help reduce pain, discomfort, and distress. Nurses and care workers should regularly check if the person is feeling unwell or in pain. If needed, they should talk to the person (or their family, friends, support network, or substitute decision-maker) about the best way to manage symptoms with medication.
Key considerations guiding medication management in the palliative phase may include:
- Reviewing medications – Does the person need to stop, reduce, or change any medication that is no longer helpful or is causing harm?
- Planning ahead (anticipatory prescribing) – Some symptoms are common in the final stages of life, such as pain, trouble breathing, restlessness, nausea, extra secretions, constipation, confusion, tiredness, anxiety, or emotional distress. Doctors and / or nurse practitioners may prescribe medications in advance so they can be given when needed, to help manage these symptoms quickly.
- Withholding or withdrawing life-sustaining treatments – Sometimes, treatments that do not help the person feel better or live well or are no longer needed should be stopped. This may be referred to as non-beneficial treatment or futile.
- Managing pain and symptoms well – It is important to manage pain and discomfort carefully throughout the palliative phase, especially in the final days of life.
These considerations are covered in greater detail below.
Medication may need to be reviewed and rationalised (deprescribing)
Medication may need to be reviewed and rationalised (deprescribing) Older people, particularly those being supported in aged care often take five or more medications (polypharmacy) to manage long-term health conditions. Taking many medications can sometimes cause harm, such as side effects or drug interactions, and may reduce quality of life.
It is important to review whether each medication is still needed, especially in the palliative phase. Some medicines, like statins (used to prevent heart attacks or strokes), may no longer be helpful. When deciding to stop a medication, health professionals and the person and/or their substitute decision maker should consider:
- the person’s care goals, quality of life, and life expectancy
- which medications are essential for their current wellbeing
- whether any medications are no longer needed or may cause harm
- the benefits and risks of stopping a medication.
Talking About Medication Changes
Clear communication is important so the person (or their substitute decision-maker) understands the reasons for stopping certain medications. Stopping some long-term medications may feel like "giving up," but it is not about hastening death - it is about making sure care is appropriate for this stage of life. Benefits of Reducing Medications Reducing or stopping unnecessary medications in palliative care can:
- prevent side effects and drug interactions
- lower the risk of falls
- help maintain clear thinking and awareness
- reduce unnecessary hospital visits.
Even when long-term medications are stopped, medications for pain and symptom relief will always be available to ensure comfort and quality of care.
Anticipatory prescribing is important
Anticipatory prescribing means ordering medications in advance to manage expected symptoms before they happen. This helps prevent distress, avoid emergencies, and reduce the need for hospital transfers.
Why Is It Important?
Having the right medication ready can:
- help manage symptoms as a person’s condition changes
- prevent uncontrolled pain and distress
- support the person’s wish to stay in their preferred place of care
- provide reassurance for families, carers, and staff.
What Can Affect Access to Medication?
Anticipatory prescribing is less effective if:
- the aged care home or service does not have the needed medication on hand
- there are delays in getting medication from a pharmacy.
Making sure medications are available
Some aged care homes have an imprest medication system. This means they keep a supply of important medications on hand, not just those prescribed for a specific person. These medications are stored under a Health Services Permit (HSP).
Why Is This Important?
- Ensures quick access to pain relief, sedation, and other end-of-life medications.
- Helps manage symptoms without delays.
- Reduces the need for urgent hospital transfers.
Each provider decides what medications to keep based on residents' needs.
Learn more: Guiding Principles for Medication Management in Residential Aged Care Facilities (2022)
Planning ahead and ensuring quick access to medication helps provide the best care in the final stages of life.
Withholding or withdrawing life-sustaining treatment, including futile or non-beneficial treatment
A person who can make decisions for themselves may choose to stop or refuse treatment or medication at any time. If they cannot make decisions, their Advance Care Directive or substitute decision-maker may refuse treatment on their behalf. These choices must be respected, even if stopping treatment means the person will die.
When Treatment Is No Longer Beneficial
In the final stage of life, doctors may decide that certain treatments or medications are no longer helpful or in the person’s best interest. This could include stopping life-prolonging treatments.
What Happens Next?
- A person or their substitute decision-maker cannot demand treatment that doctors believe is not beneficial.
- Any changes to medications should be clearly documented to avoid confusion for other healthcare providers.
- Pain and symptom relief must continue to keep the person comfortable, even if other treatments stop.