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General Practitioners’ decisions about prescribing end-of-life anticipatory medications: a qualitative study

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Barclay, Sam 
Pollock, Kristian 


Background: GPs have a central role in decisions about prescribing anticipatory medications to help control symptoms at the end-of-life. Little is known about GPs’ decision-making processes in prescribing anticipatory medications, how they discuss this with patients and families, and the subsequent use of prescribed drugs.

Aim: To explore GPs decision-making processes in the prescribing and use of anticipatory medications for patients at the end-of-life.

Design and setting: A qualitative interview study with GPs working in one English county.

Methods: Semi-structured interviews with a purposive sample of thirteen GPs. Interview transcripts were analysed inductively using thematic analysis.

Results: Three themes were constructed from the data: 1) “Something we can do”. Anticipatory medications were a tangible intervention GPs felt they could offer patients approaching death. 2) “Getting the timing right”. The prescribing of anticipatory medications was recognised as a harbinger of death for patients and their families. Nevertheless, GPs preferred to discuss and prescribe anticipatory medications weeks before death was expected whenever possible. 3) “Delegating care whilst retaining responsibility”. After prescribing medications, GPs relied on nurses to assess when to administer drugs and keep them updated about their use.

Conclusions: GPs view anticipatory medications as key to symptom management for end-of-life patients. The drugs are often presented as a clinical recommendation to ensure patients and families accept the prescription. GPs need regular access to nurses and rely on their skills to administer drugs appropriately. Patient and family experiences of anticipatory medications, and their preferences for involvement in decision-making warrant urgent investigation.



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British Journal of General Practice

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Royal College of General Practitioners

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National Institute for Health Research (NIHR) (via University of Oxford) (Capacity Building Award 9)
National Institute for Health Research NIHR School for Primary Care Research. National Institute for Health Research Applied Research Collaboration East of England.