Accessing and administering anticipatory medications for community end-of-life symptom control: A qualitative focus group study

Aim: To understand healthcare professionals’ perceptions of what works well and what can be improved in the supply and administration of anticipatory medications at the end of life in the community. Design: Focus group qualitative, interpretive study. Methods: Semi-structured focus groups included healthcare professionals with experience of using anticipatory medications, and public contributors whose experiences involved relatives’ end-of-life care. Participants’ demographic information was elicited in a brief questionnaire. Transcripts were analysed inductively using thematic analysis. Data were collected in September 2022. Setting and participants: Eight focus groups involved 58 UK-based participants. Each group included people with a variety of professional roles from diverse geographical areas, and public contributors with relevant lived experiences. Results: Administration of anticipatory prescriptions was widely perceived to be a valuable intervention, but extensive operational challenges were identified, with three interconnected themes arising from the data: a) Communication between healthcare teams; b) Intuitive documentation; c) Accessibility of medications. Addressing these challenges was perceived to be onerous, particularly for nurses and patients’ families. Conclusions: Operational barriers to the timely and appropriate administration of anticipatory medications risk were perceived as adversely affecting patient care and patients’ and families’ experiences. Implications for the Profession and/or Patient Care: System-level improvements are needed to streamline care processes, and ensure equitable, appropriate, and timely access to end-of-life symptom control medications in the community.