Unwelcome memento mori or best clinical practice? Community end of life anticipatory medication prescribing practice: A mixed methods observational study

Sage Palliative Medicine & Chronic Care

This episode features Dr Ben Bowers (Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK). The prescribing of injectable anticipatory medications to provide symptom relief in the last days of life is recommended and widespread practice in a number of counties. There is limited research concerning the frequency, timing and context of prescriptions. Half (50.8%) of 329 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. Patients’ and family carers’ involvement in prescribing decisions was unclear. 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.