Oral or IV Medicine Decision Making at the End of Life

When discussing end-of-life care, it is imperative to include the patient, immediate family members, and caregivers, declares Bruce A. Feinberg, DO, vice president and chief medical officer of Cardinal Health Specialty Solutions. “I always want to have someone else in the room [besides the patient] when discussing a treatment change,” he says, “mostly because patients often are in shock.” This should not necessarily be estranged family members, who have been absent from the patient’s affairs for several years and suddenly want to insert themselves into the patient’s decisions, cautions Dr Feinberg. But including the key caregiver in decisions made at critical steps is very valuable, he said.

Being as inclusive as possible while being sensitive to the family situation is the best strategy for the oncologist, adds Brian B. Kiss, MD, vice president, healthcare transformation, Blue Cross Blue Shield of Florida.

The choice of intravenous versus oral medications in palliative care makes a discussion about medication therapy management (MTM) very important, mostly related to the expense of the oral oncolytics. We want to use these medications most efficiently, points out Dr Feinberg, and “patient self-care plans” must include more than just MTM to ensure adherence with the care plan. He admits that MTM may be driven by a specialty pharmacy need “rather than a great need across healthcare.” He singles out the opportunity for mobile health technologies, especially text-based reminders, to improve adherence and persistence with oral therapy, manage side effects, or to remind patients to keep up with general care.

Patient adherence is the key, agrees Dr Kiss, whether it is an oncology therapy or general medical treatment. He states that different patients need different types of point of contact, whether they receive texts, phone calls, or pill bottles that automatically remind them to comply with the treatment regimen.