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Anticipatory prescribing in community end-of-life care in the UK and Ireland during the COVID-19 pandemic: online survey
  1. Bárbara Antunes1,
  2. Ben Bowers1,
  3. Isaac Winterburn1,
  4. Michael P Kelly1,
  5. Robert Brodrick2,3,
  6. Kristian Pollock4,
  7. Megha Majumder1,
  8. Anna Spathis1,
  9. Iain Lawrie5,6,
  10. Rob George7,8,
  11. Richella Ryan1,2 and
  12. Stephen Barclay1
  1. 1 Department of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, Cambridgeshire, UK
  2. 2 Community Specialist Palliative Care Team, Arthur Rank Hospice Charity, Cambridge, UK
  3. 3 Palliative Medicine, Papworth Hospital NHS Foundation Trust, Cambridge, UK
  4. 4 School of Nursing, University of Nottingham, Nottingham, Nottinghamshire, UK
  5. 5 Palliative Medicine, North Manchester General Hospital, Manchester, UK
  6. 6 Manchester Medical School, The University of Manchester, Manchester, UK
  7. 7 Medicine, St Christopher's Hospice, London, UK
  8. 8 Cicely Saunders Institute, King's College London School of Medical Education, London, UK
  1. Correspondence to Bárbara Antunes, Department of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge CB2 0SR, Cambridgeshire, UK; bc521{at}


Background Anticipatory prescribing (AP) of injectable medications in advance of clinical need is established practice in community end-of-life care. Changes to prescribing guidelines and practice have been reported during the COVID-19 pandemic.

Aims and objectives To investigate UK and Ireland clinicians’ experiences concerning changes in AP during the COVID-19 pandemic and their recommendations for change.

Methods Online survey of participants at previous AP national workshops, members of the Association for Palliative Medicine of Great Britain and Ireland and other professional organisations, with snowball sampling.

Results Two hundred and sixty-one replies were received between 9 and 19 April 2020 from clinicians in community, hospice and hospital settings across all areas of the UK and Ireland. Changes to AP local guidance and practice were reported: route of administration (47%), drugs prescribed (38%), total quantities prescribed (35%), doses and ranges (29%). Concerns over shortages of nurses and doctors to administer subcutaneous injections led 37% to consider drug administration by family or social caregivers, often by buccal, sublingual and transdermal routes. Clinical contact and patient assessment were more often remote via telephone or video (63%). Recommendations for regulatory changes to permit drug repurposing and easier community access were made.

Conclusions The challenges of the COVID-19 pandemic for UK community palliative care has stimulated rapid innovation in AP. The extent to which these are implemented and their clinical efficacy need further examination.

  • end of life care
  • drug administration
  • home care
  • terminal care
  • supportive care
  • nursing home care

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  • Contributors BA and SB designed and co-led the study: MPK, RB, RR, AS, IW and BB contributed to the survey design; BB supported dissemination of the online survey; BA, IW, BB and SB conducted the data analysis; BA, BB, IW and SB drafted the paper; all the authors reviewed and commented on the draft paper and have approved this final version.

  • Funding BA, IW and SB are funded by the National Institute for Health Research (NIHR) Applied Research Collaboration East of England (ARC EoE) programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. BB is funded by the National Institute for Health Research (NIHR) School for Primary Care Research.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement No data are available. This is a preliminary analysis of the interim dataset obtained by 19 April 2020. Data collection is ongoing: a further paper is planned in the future once further responses have been received and a more detailed analysis of the dataset has been undertaken.

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