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• W3135585890 abstract "Abstract Background Anticipatory medications are injectable drugs prescribed ahead of possible need for administration if distressing symptoms arise in the final days of life. Little is known about how they are prescribed in primary care. Aim To investigate the frequency, timing and recorded circumstances of anticipatory medications prescribing for patients living at home and in residential care. Design Retrospective mixed methods observational study using General Practitioner and community nursing clinical records. Setting/participants 329 deceased adult patients registered with Eleven General Practitioner practices and two associated community nursing services in Hertfordshire and Cambridgeshire, England (30 most recent deaths per practice). Patients died from any cause except trauma, sudden death or suicide, between 4 March 2017 and 25 September 2019. Results Anticipatory medications were prescribed for 167/329 (50.8%) of the deceased patients, between 0 and 1212 days before death (median 17 days). The likelihood of prescribing was significantly higher for patients with a recorded preferred place of death (odds ratio [OR] 34; 95% CI 15-77; p < 0.001) and specialist palliative care involvement (OR 7; 95% CI 3-19; p < 0.001). For 66.5% of patients (111/167) anticipatory medications were recorded as being prescribed as part of a single end of-life planning intervention. Conclusion The variability in the timing of prescriptions highlights the challenges in diagnosing the end-of-life phase and the potential risks of prescribing far in advance of possible need. Patient and family preferences for involvement in anticipatory medications prescribing decision-making and their experiences of care warrant urgent investigation. Summary Box What is already known on this topic The prescribing of injectable anticipatory medications to provide symptom relief in the last days of life care is recommended and widespread practice in a number of counties. There is limited research concerning the frequency, timing and context of prescriptions. What this paper adds Half (50.8%) of 319 patients whose deaths were potentially predictable deaths were prescribed anticipatory medications, the timing of prescriptions ranging from 0 to 1212 days before death (median 17 days). Anticipatory medications were frequently prescribed as standardised drugs and doses, and often as part of a single end-of-life care planning intervention. The extent to which patients and family carers were involved in prescribing decisions was unclear. Implications for practice, theory or policy Patient and family preferences for involvement in anticipatory medications prescribing decision-making and their experiences of care warrant urgent investigation. The presence of anticipatory medications for long periods of time may compromise patient safety unless robust systems are in place to review their continued appropriateness and safe use." @default.
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• W3135585890 date "2021-03-01" @default.
• W3135585890 modified "2023-10-17" @default.
• W3135585890 title "Unwelcome memento mori or best clinical practice? Community end-of-life anticipatory medication prescribing practice: a mixed methods observational study" @default.
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• W3135585890 doi "https://doi.org/10.1101/2021.02.25.21252474" @default.
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