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GPs’ decisions about prescribing anticipatory medicines at the end of life: a qualitative study

Ben Bowers, Kristian Pollock, Sam Barclay and Stephen Barclay
British Journal of General Practice 2019; 69 (suppl 1): bjgp19X702809. DOI: https://doi.org/10.3399/bjgp19X702809
Ben Bowers
The Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine Email:
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  • For correspondence: bb527@medschl.cam.ac.uk
Kristian Pollock
Faculty of Medicine and Health Sciences, University of Nottingham
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Sam Barclay
The Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine
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Stephen Barclay
The Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine
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Abstract

Background GPs have a central role in decisions about prescribing anticipatory medications (AMs) to help control symptoms at the end of life. Little is known about GPs’ decision-making processes in prescribing AMs and the subsequent use of prescribed drugs.

Aim To explore GPs’ decision-making processes in the prescribing and use of AMs for patients at the end of life.

Method A qualitative interpretive descriptive enquiry with a purposive sample of 13 GPs working across one English county. Data was collected in 2017 via semi-structured interviews and analysed inductively using Braun and Clarke’s thematic analysis.

Results Three themes were constructed from the data: 1) ‘Something we can do’: AMs were a tangible intervention GPs felt they could offer to provide symptom relief for patients approaching death. 2) ‘Getting the timing right’: the prescribing of AMs was recognised as a harbinger of death for patients and families. GPs preferred to prescribe drugs weeks before death was expected, while recognising this meant that many prescribed AMs were never used. 3) ‘Delegating care while retaining accountability’: GPs relied on nurse to assess when to administer drugs and keep them updated about their use.

Conclusion GPs view AMs as key to symptom management for dying people. AMs are routinely prescribed even though they are often not used. In order to feel comfortable delegating care, GPs need regular access to nurses and trust in their skills to administer drugs appropriately. Patient and family experiences of AMs, and their preference for involvement in decision-making about their use warrant urgent investigation.

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British Journal of General Practice: 69 (suppl 1)
British Journal of General Practice
Vol. 69, Issue suppl 1
June 2019
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GPs’ decisions about prescribing anticipatory medicines at the end of life: a qualitative study
Ben Bowers, Kristian Pollock, Sam Barclay, Stephen Barclay
British Journal of General Practice 2019; 69 (suppl 1): bjgp19X702809. DOI: 10.3399/bjgp19X702809

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GPs’ decisions about prescribing anticipatory medicines at the end of life: a qualitative study
Ben Bowers, Kristian Pollock, Sam Barclay, Stephen Barclay
British Journal of General Practice 2019; 69 (suppl 1): bjgp19X702809. DOI: 10.3399/bjgp19X702809
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Print ISSN: 0960-1643
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