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11 How is anticipatory prescribing in community end of life care governed in the UK? A content analysis of national and local guidance documents
  1. Richella Ryan,
  2. Ben Bowers,
  3. Anna Spathis and
  4. Stephen Barclay
  1. University of Cambridge


Introduction Anticipatory prescribing (AP) in end of life care is a complex process consisting of at least 5 sequential phases: 1) decision to prescribe, 2) prescribing and dispensing, 3) set-up, storage and monitoring, 4) assessment and administration, and 5) post-death procedures. Little is known about how this process is governed across the UK. We aimed to investigate the scope and content of UK AP governance documents.

Methods Stakeholders from a stratified random sample of 55 CCG areas in England and all health board (or equivalent) areas of Scotland (n=14), Wales (n=7) and Northern Ireland (n=5) were asked to supply their AP governance documents. Qualitative and quantitative content analysis was conducted using the 5 phases of AP as an analytical framework. A typology of approach to AP governance was developed.

Results 49 sets of documents, 5 national (representing all 4 countries) and 44 local (33 English, 11 Scottish) were analysed. Two predominant types of approaches to AP governance were identified. Type 1 ‘Last Days of Life Care’: AP guidance is embedded within ‘last days of life’ symptom management guidelines and is usually limited to the prescribing and administration phases (predominant in England and NI). Type 2 ‘Anticipatory Care’: AP guidance covers more than the ‘last days of life’ period and documents specifically address all 5 phases of the AP process (predominant in Scotland). National frameworks supporting both approaches exist in Wales. Significant guidance gaps were identified with the type 1 approach, particularly in relation to: 1) timing of the decision to prescribe, 2) transition from prescription to administration, and 3) drug disposal.

Conclusions Despite its complexity, AP is often treated as a simple component of ‘last days of life care’ within governance documents, resulting in important guidance gaps. National guidance development work is underway to address these gaps.

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