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Anticipatory prescribing in terminal care at home: what challenges do community health professionals encounter?
  1. Christina Faull1,
  2. Kate Windridge2,
  3. Elizabeth Ockleford2 and
  4. Michael Hudson1
  1. 1LOROS, The Leicestershire and Rutland Hospice, Leicester, UK
  2. 2Department of Health Sciences, University of Leicester, NIHR RDS East Midlands, Leicester, UK
  1. Correspondence to Dr Christina Faull, LOROS, The Leicestershire and Rutland Hospice, Groby Road, Leicester LE3 9QE, UK; Christinafaull{at}loros.co.uk

Abstract

Background The prompt availability of medications to manage symptoms is key to high quality end-of-life care and anticipatory prescribing of these drugs is thought good practice. This study explored the challenges encountered by primary and community health professionals in Leicestershire and Rutland related to anticipatory prescribing when caring for terminally ill patients who wish to remain at home to die.

Method A qualitative study was conducted using eight focus groups (54 participants) and nine individual interviews with a purposively sampled range of health professionals providing care for people who wished to die at home. Themes were identified iteratively via constant comparison.

Results Challenges fell into four categories: resourcing concerns, professional expertise/experience, professionals’ relationships with patients, and professionals’ relationships with other professionals. The latter included the most serious perceived challenges. Links between community and hospital care providers and between ‘usual’ hours and ‘out-of-hours’ care providers were seen as particularly unstable.

Conclusions These findings suggest that building and maintaining trusting, responsive, personal links between professionals, both within and between teams, is essential when implementing good practice guidelines about anticipatory end-of-life prescribing in the community. The need for good communication and relationships between patients and professionals and maintaining expertise and confidence in end-of-life care are also key factors in the effective use of anticipatory prescribing for symptom management for dying patients.

  • Received 4 January 2012.
  • Accepted 7 August 2012.

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  • Received 4 January 2012.
  • Accepted 7 August 2012.
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