Continuity and empathetic connections when care is needed urgently: lessons from a qualitative study of injectable medication in end-of-life care

Abstract

Background Seeing the same clinician over time can nurture therapeutic relationships between clinician and patient. Because this relational continuity can seldom be achieved in urgent care, “access” and “continuity” are often presented as mutually exclusive, and it might be assumed that therapeutic relationships, too, would necessarily be sacrificed to speedy response. Offering symptom-relieving injections, an important palliative care intervention, is often needed urgently outside normal working hours. Aim To explore how continuity and empathy may be enacted in urgent care, drawing on stakeholders’ experiences of symptom-relieving injections in community palliative care. Design and Setting Qualitative interview study with patients and their family carers and community nurses, in eastern England. Method Semi-structured interviews with eleven patients, ten informal carers and fifteen nurses (thirty-eight interviews in total). Patients had been prescribed injectable symptom-relieving medication to be kept at home in case of need, and were identified by their usual community clinicians as approaching the end of life. Interviews were conducted either at a patient’s home or by telephone, between April 2024 and August 2025. Data were analysed thematically using constant comparison. Results Participants described the package of support centred on injectable medication as beneficial. All identified two elements as key to this benefit: empathy and rapport in clinical encounters; and the medication itself. Additionally, nurses emphasised the importance of systems providing information and coherent organisation; patients and relatives mainly mentioned occasions where these failed to work smoothly. Conclusion Alongside information and management continuity, empathetic connections are important and achievable in urgent care.