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End of life care in UK care homes – controlled drugs: systematic review and narrative synthesis
  1. Megha Majumder1,
  2. Ben Bowers1,
  3. Kristian Pollock2,
  4. Claire Goodman3,
  5. Isla Kuhn4 and
  6. Stephen Barclay1
  1. 1 Public Health and Primary Care, University of Cambridge, Cambridge, UK
  2. 2 Nottingham Centre for the Advancement of Research into Supportive, Palliative and End of Life Care, School of Health Sciences, University of Nottingham, Nottingham, UK
  3. 3 Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
  4. 4 Medical Library, University of Cambridge, Cambridge, UK
  1. Correspondence to Megha Majumder; mm2426{at}


Background Controlled drugs (CDs) such as opioids and midazolam are commonly used in end-of-life care symptom management for care home residents.

Aim To review the published evidence concerning the prescribing, storage, use and disposal of CDs for end-of-life care for care home residents in the UK.

Design Systematic review and narrative synthesis.

Methods Seven databases (Medline, CINAHL, Embase, PsycINFO, Web of Science, Cochrane Library, and Social Care Online) were searched from January 2000 to January 2021, alongside reference, citation and journal hand searches. Gough’s ‘Weight of Evidence’ framework was used to appraise the relevance of studies to the review questions.

Results The search yielded 1279 titles, from which 125 abstracts and then 42 full-text papers were screened. 14 papers were included in the synthesis. Prescribing is primarily by general practitioners, with administration by nurses. Nurses frequently report feeling inadequately trained in the use of CDs. The storage, monitoring and disposal of end-of-life care CDs in UK care homes has not been researched to date. The attitudes and experiences of residents and family members regarding these medications also remain unknown.

Conclusion The current widespread use of CDs for end-of-life care in care homes has a limited evidence base. The lack of research concerning the storing, monitoring and disposing of CDs, alongside the limited evidence concerning resident and family members’ perspectives, is a significant knowledge deficit that requires urgent attention.

PROSPERO registration number CRD42020173014.

  • terminal care
  • symptoms and symptom management
  • pharmacology
  • pain
  • nursing home care
  • clinical decisions

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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  • Twitter @megmajumder, @Ben_Bowers__, @ilk21

  • Contributors MM, BB, SB, KP, CG and IK contributed to the design and implementation of the research. MM (guarantor), BB, SB, KP and CG contributed to the analysis of the results and to the writing and editing of the manuscript.

  • Funding MM is funded by the Abbeyfield Foundation (Grant No 23), which has funded this research. SB and CG are supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East of England (ARC EoE) programme. BB is funded by the NIHR School for Primary Care Research.

  • Disclaimer 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.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.