Background Anticipatory Medicines (AM) are injectable medicines prescribed and administered for patients to alleviate symptoms at the End of Life (EOL). Whilst prescribing of these medicines is encouraged by the healthcare system in Leicester, Leicestershire and Rutland, the real life experiences of healthcare professionals and surviving relatives, have not been previously documented locally, and are only in limited detail in academic literature. This project was conducted as part of an MSc in Palliative Care.

Aim To interview key stakeholders, including healthcare professionals and surviving relatives, regarding their experiences of prescribing, administering, dispensing and observing AM at the EOL.

Method Semi-structured interviews were conducted as individuals or in small groups, with both healthcare professionals and relatives. These were: Community Palliative Care Nurses (5), Hospice at Home Nurses (4), District Nurses (1), General Practitioners (3), Community Pharmacists (1), and Relatives (2). Qualitative thematic analysis of interviews was conducted identifying clusters of themes, themes and sub-themes.

Results There were two main clusters of themes; Decision points in AM; and Goals of treatment. There were nine themes which all influenced the main clusters which included; patient experience; family experience, emotions; finances; improvements; multidisciplinary working; decision making service delivery; and standardised systems. Each theme had promoting and inhibiting factors, which would affect the Decision Points and Goals of Treatment. Overall, standardised systems were felt to have improved the Goals of Treatment. Variations in service delivery, decision making, MDT working and financial concerns all potentially adversely affect the Goals of Treatment. All interviewees indicated one key element, the importance of managing symptoms at the EOL: ’The patient died peacefully at home’.

Conclusions Decisions about AM, and meeting the Goals of Treatment, are part of a complex healthcare system.

Effective EOL symptom management in the community is important for patients, relatives and carers, and healthcare professionals, and AM play an important role to achieve this.

Further research is indicated to interview greater numbers of key stakeholders to expand on this work.