Factors Associated With Benzodiazepine and Antipsychotic Prescribing in Hospice: A Qualitative Study of Hospice Prescribers.
Lauren B Gerlach, Molly Turnwald, Kristin Geczi and 4 others
PMID 37230152WHAT IT FOUND
Hospice prescribers report that high caregiver stress often triggers benzodiazepine or antipsychotic use, even when non-drug options exist.
Nursing home policies restricting antipsychotics frequently shift prescribing to benzodiazepines or result in physical restraints.
Key findings
01Clinicians are more likely to prescribe sedatives or antipsychotics when they perceive the patient's caregiver as highly stressed or lacking capacity to manage behaviors.
02In nursing homes, strict internal policies against antipsychotics to protect quality ratings often lead to increased benzodiazepine use or physical restraints instead.
03Prescribing is frequently driven by the need to prevent hospitalization or facility transfer when end-of-life behaviors become unmanageable in the current setting.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only physicians and nurse practitioners, excluding registered nurses, social workers, and pharmacists who also influence hospice care. Participants were recruited from a professional society, which may not represent the views of all hospice clinicians. The sample size (23) is small, though thematic saturation was reported. Self-reported prescribing motivations may differ from actual clinical behavior.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institute on Aging (N.I.H., Extramural).
The easy way to misread this
Do not interpret these themes as evidence that prescribing benzodiazepines or antipsychotics improves patient outcomes. The study reports clinician perceptions of why they prescribe, not the effectiveness or safety of those medications in this population.