22 General practitioners’ decisions about prescribing anticipatory medicines at the end of life: a qualitative study

Abstract

Background General Practitioners (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, how they discuss this with patients and families, 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. Methods A qualitative interpretive descriptive enquiry with a purposive sample of thirteen GPs working across one English county. Data were collected between June and December 2017 via audio recorded 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 their families. GPs would discuss AMs when they felt patients were ready, preferring to prescribe drugs weeks before death was expected whenever possible, while recognising this meant that many prescribed AMs were never used. (3) ‘Delegating care whilst retaining accountability’. After prescribing medications, 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 have not been studied to date: we are addressing this important knowledge gap.