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Simultaneously reassuring and unsettling: a longitudinal qualitative study of community anticipatory medication prescribing for older patients

Bowers, Ben; Pollock, Kristian; Barclay, Stephen

Authors

Ben Bowers

Stephen Barclay



Abstract

Background: The prescription of injectable anticipatory medications is widely accepted by clinicians to be key in facilitating effective last-days-of-life symptom control. Community end-of-life care and admission avoidance is particularly strongly advocated for older patients. However, patient and informal caregiver views and experiences of anticipatory medication have been little studied to date. Objective: To understand older patients', informal caregivers' and clinicians' views and experiences of the prescribing and use of anticipatory medications. Design: Qualitative study. Setting: Patients' homes and residential care homes. Participants: Purposive sample of six older patients, nine informal caregivers and six clinicians. Methods: Multi-perspective, longitudinal interview study based on 11 patient cases. Semi-structured interviews (n = 28) were analysed thematically. Results: Three themes were identified: (i) living in the present whilst making plans: anticipatory medications were used by clinicians as a practical tool in planning for uncertainty, while patients and informal caregivers tried to concentrate on living in the present; (ii) anticipation of dying: it was rare for patients and informal caregivers to discuss explicitly the process and experience of dying with clinicians; and (iii) accessing timely care: the use of anticipatory medications generally helped symptom control. However, informal caregivers reported difficulties in persuading nurses to administer them to patients. Conclusions: Anticipatory medications are simultaneously reassuring and a source of unease to older patients and their informal caregivers. Prescriptions need careful discussion and tailoring to their preferences and experience. Nurses' decisions to administer medication should consider informal caregivers' insights into patient distress, especially when patients can no longer communicate their needs.

Citation

Bowers, B., Pollock, K., & Barclay, S. (2022). Simultaneously reassuring and unsettling: a longitudinal qualitative study of community anticipatory medication prescribing for older patients. Age and Ageing, 51(12), Article afac293. https://doi.org/10.1093/ageing/afac293

Journal Article Type Article
Acceptance Date Oct 17, 2022
Online Publication Date Dec 8, 2022
Publication Date 2022-12
Deposit Date Dec 12, 2022
Publicly Available Date Jan 5, 2023
Journal Age and Ageing
Print ISSN 0002-0729
Electronic ISSN 1468-2834
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 51
Issue 12
Article Number afac293
DOI https://doi.org/10.1093/ageing/afac293
Keywords Anticipatory prescribing, home palliative care, decision-making, end-of-life care, qualitative methods, older people
Public URL https://nottingham-repository.worktribe.com/output/14602467
Publisher URL https://academic.oup.com/ageing/article/51/12/afac293/6881500

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