Medication use in palliative care is shaped simultaneously by symptom relief, prevention of avoidable harm, changing prognosis, multimorbidity, polypharmacy, treatment burden, professional responsibility, and patient and family priorities. These dimensions are often considered separately, creating uncertainty about how medication safety should be interpreted when goals of care change. To integrate multidisciplinary evidence on medication burden, medication-related harm, potentially inappropriate medication use, deprescribing, professional roles, care-setting variation, and participation by patients and families in palliative medication decisions. An integrative multidisciplinary review was conducted using a reproducible search and selection process covering literature published from 2017 through 2026. Eighty-eight records were identified through structured searches, 24 duplicates were removed, and 64 unique records underwent screening. Thirty-seven reports were sought, 34 were assessed in sufficient detail, and 27 independent evidence units were included. Results: Medication burden was common across palliative, advanced-cancer, long-term-care, hospice, and community populations, but medication number, anticholinergic or sedative burden, potentially inappropriate prescribing, and medication-related harm represented different constructs. Professional contributions also differed: nurses were positioned principally within administration, surveillance, recognition, communication, and escalation; pharmacists contributed medication reconciliation, medication review, drug-related-problem identification, and recommendations; prescribing and multidisciplinary decisions incorporated prognosis, indication, symptom priorities, benefit–burden judgments, and patient preferences. Medication safety in palliative care cannot be inferred from medication count or deprescribing activity alone. A defensible interpretation requires distinguishing medication burden, realized harm, prescribing appropriateness, medication change, professional responsibility, patient and caregiver participation, and the care environment in which decisions occur.
