Utilizing Pharmacogenetic Results to Optimize Medication Management in Hospice Care: A Pilot Study

Background: Pharmacogenetics (PGx), which examines how genetic variations influence drug metabolism and response, offers promise in hospice care where patients commonly experience polypharmacy, complex symptoms, and limited life expectancy. This study assessed the utility of PGx results in guiding medication adjustments to improve symptom management at the end of life. Methods: A retrospective chart review was conducted on ten patients enrolled in a Precision Hospice Program who had PGx results for six key metabolic genes. A PGx-trained pharmacist reviewed Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline-based recommendations, which were discussed during interdisciplinary hospice team meetings. Results: Patients had a mean age of 85.7 years and were prescribed an average of 17.9 medications. Among the 27 prescriptions reviewed, actionable gene-drug interactions were identified, primarily involving antidepressants and analgesics. Three patients underwent medication changes based on PGx guidance, including switching from citalopram to bupropion and adding morphine to tramadol therapy, which improved symptom control. Conclusion: While not yet routinely implemented in hospice settings, this pilot study suggests PGx-guided prescribing can support personalized medication decisions and enhance emotional and physical comfort in end-of-life care when test results are available.