Precision pharmacopalliation: The Goldilocks' approach to medication management at end of life

Medications play a pivotal role in managing pain and other symptoms of patients with advanced illness. However, the medication regimen must be continuously subjected to scrutiny, evaluating the benefits and burdens of therapy. The term 'precision pharmacopalliation' defines a medication regimen consisting of the correct types, amounts and doses of medications to provide effective palliative care, maximising benefit while minimising burden. To achieve this level of precision, the practitioner must first accurately reconcile the patient's medication regimen, then screen for and resolve drug-related problems (such as need for additional drug therapy, use of unnecessary drugs, inappropriate drug selection, incorrect dosing, adverse drug reactions and lack of medication adherence). Palliative care practitioners must also be skilled at knowing how to discontinue medications (abruptly vs tapering), and how to explain the continuous fine-tuning of the medication regimen to patients, families, caregivers and other healthcare professionals. Precision pharmacopalliation is an essential part of effective symptom management at end of life.