Objective: We aim to identify the current practice at the Royal Devon & Exeter NHS trust of managing Patients with PD at the end of their life.

Background: End of life care in Parkinson’s disease (PD) can be complicated, patients can experience a wide range of debilitating symptoms which can be exacerbated by many of the medications routinely used in end of life care. As patients with PD reach the end of their life, medication administration becomes challenging due to swallowing difficulties and patients with PD may be inappropriately deprived of PD medications^1,2. Parkinson’s UK and the Peninsula Parkinson’s Excellence network have therefore highlighted palliative care as an area of focus.

Methods: All patients with idiopathic PD who died in hospital between 2013 and 2015 were sampled (N=30) from the Movement disorders database. Deaths within 24 hours of admission were excluded. It was a retrospective notes audit. One clinician reviewed all patients’ notes and drug charts, documenting the medications used and the clinical management in the end of life process.

Results: Of 30 patients included, 23% (7) received contraindicated medications, mostly cyclizine (16%) and levomepromazine (7%). A further 20% (6) had contraindicated medications prescribed but did not receive them. Dopaminergic medication was stopped prematurely in 33% (10) cases and alternative routes of administration of dopaminergic medication were considered in 90%.  The specialist PD team was involved in 77% (23).

Conclusions: There is room for improvement in PD palliative care at the RD&E. We are designing PD palliative care guidance which emphasises avoidance of contraindicated medications, consideration of alternative routes of administration, continuation of dopaminergic medications and early involvement of the PD specialist team.

References: 1. Bradburn E, Malik Q, Sin-Hidge C, Lund S, Bowen J, Howard P, et al. Improving end of life care in Parkinson’s disease. Journal of Parkinson’s Disease 2013;3:193-4.

2. Saleem TZ, Higginson IJ, Chaudhuri KR, Martin A, Burman R, Leigh PN. Symptom prevalence, severity and palliative care needs assessment using the Palliative Outcome Scale: a cross-sectional study of patients with Parkinson’s disease and related neurological conditions. Palliat Med 2013 Sep;27(8):722-31.
 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/end-of-life-care-in-parkinsons-disease/