Managing medications for patients with serious illness being cared for and dying at home
This study aimed to explore how patients with serious, life limiting and terminal illness, their family care givers and the health care professionals who support them engage collaboratively in managing medicines prescribed for relief of symptoms towards the end of life.
It provided evidence from a detailed study of barriers, facilitators, information and training needs for the improved support at home of patients with serious, life limiting and terminal illness and their families.
Publications
- Antunes, B., et al., Anticipatory prescribing in community end-of-life care in the UK and Ireland during the COVID-19 pandemic: online survey. BMJ Supportive and Palliative Care, 2020. 10:343–349.
- Bowers, B., et al., General Practitioners’ decisions about prescribing anticipatory medications at the end-of-life: a qualitative study. British Journal of General Practice, 2020. 70 (699): e731-e739. DOI: https://doi.org/10.3399/bjgp20X712625s
- Bowers, B., K. Pollock, and S. Barclay, Administration of end-of-life drugs by family caregivers during covid-19 pandemic. BMJ, 2020. 369: p. m1615.
- Bowers, B., et al., Anticipatory syringe drivers: a step too far. BMJ Supportive and Palliative Care, 2019. 9: p. 149-150.
- National Institute of Health Research (NIHR) Alert: Terminally ill patients and their families often need more help to manage their medicines.Published on 16 September 2020 doi: 10.3310/alert_41179
- Latif A; Faull C; Wilson E; Caswell G; Ali A; Anderson C; Pollock K. Managing medicines for patients with palliative care needs being cared for at home: Insights for community pharmacy professionals. Pharmaceutical Journal https://www.pharmaceutical-journal.com/cpd-and-learning/learning/caring-for-palliative-care-patients-at-home-medicines-management-principles-and-considerations/20207954.article
- Latif, A., Faull, C., Waring, J., Wilson, E., Anderson, C., Avery, A., & Pollock, K. (2021). Managing medicines at the end of life: a position paper for health policy and practice. Journal of Health Organization and Management, 35(9), 368-377. https://doi.org/10.1108/JHOM-11-2020-0440
- Pollock K, W. E., Caswell G, Latif A, Caswell A, Avery A, et al. . (2021). First look summary: Managing medicine for patients with serious Illness being cared for at home. NIHR Health Services and Delivery Research. https://doi.org/https://fundingawards.nihr.ac.uk/award/15/70/101
- Pollock, K., Wilson, E., Caswell, G., Latif, A., Caswell, A., Avery, A., Anderson, C., Crosby, V., & Faull, C. (2021). Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study. 9, 14. https://doi.org/10.3310/hsdr09140
- Wilson, E., Caswell, G., Latif, A. Anderson, C., Faull C., and Pollock, K. An exploration of the experiences of professionals supporting patients approaching the end of life in medicines management at home. A qualitative study. BMC Palliat Care 19, 66 (2020). https://doi.org/10.1186/s12904-020-0537-z
- Wilson, E, Caswell, G, Turner, N and Pollock, K (2018) Managing Medicines for Patients Dying at Home: A Review of Family Caregivers' Experiences. Journal of Pain and Symptom Management. Published Online: September 11, 2018 Vol 56(6):962-974 Dec 2018 https://doi.org/10.1016/j.jpainsymman.2018.08.019
- Wilson, E., Caswell, G., & Pollock, K. (2021). The ‘work’ of managing medications when someone is seriously ill and dying at home: A longitudinal qualitative case study of patient and family perspectives’. Palliative Medicine. https://doi.org/10.1177/0269216321103011
New evidence indicates the need to rethink anticipatory prescribing
This University of Cambridge research alert brings together evidence on anticipatory prescribing, the widely used resource for healthcare professionals to help control distressing symptoms for people dying in the community.
The evidence identifies important problems with current practice in the UK and suggests system-level changes to tackle four areas for action.
Summary
Anticipatory prescribing is a widespread clinical intervention aiming to help control distressing symptoms for people dying of expected causes at home, or in care homes.
This is a complex intervention involving multiple steps, several layers of teamwork and nuanced, skilled judgements about both when to prescribe and how to use medication.
- The standardised medications and doses that are prescribed are not always clinically appropriate.
- The practice is prone to miscommunication and adverse patient safety events, especially when several healthcare professionals and services are involved.
- Anticipatory medication carries great symbolic and emotional impact for patients and families, signifying the imminence of death.
- The practice places a heavy burden of responsibility on family carers: they are expected to manage supplies, request use of medicines and securely dispose of them.
System-level changes are needed to ensure:
- Responsive communications between families and healthcare professionals;
- Clinically appropriate prescribing and administration of the medications;
- 24/7 access to community pharmacies and to healthcare professionals;
- Supportive clinician partnerships with family carers.
The research on which the briefing is based was led by Dr Ben Bowers at the Palliative and End of Life Care Research group (PELiCam) at the Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge. See the full briefing on our website or via Adobe.