• Ben Bowers, Kristian Pollock, and Stephen Barclay.
• Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
• Palliat Med. 2022 Jan 1; 36 (1): 9510495-104.

BackgroundAnticipatory medications are injectable drugs prescribed ahead of possible need for administration if distressing symptoms arise in the final days of life. Little is known about how they are prescribed in primary care.AimTo investigate the frequency, timing and recorded circumstances of anticipatory medications prescribing for patients living at home and in residential care.DesignRetrospective mixed methods observational study using General Practitioner and community nursing clinical records.Setting/Participants329 deceased adult patients registered with Eleven General Practitioner practices and two associated community nursing services in two English counties (30 most recent deaths per practice). Patients died from any cause except trauma, sudden death or suicide, between 4 March 2017 and 25 September 2019.ResultsAnticipatory medications were prescribed for 167/329 (50.8%) of the deceased patients, between 0 and 1212 days before death (median 17 days). The likelihood of prescribing was significantly higher for patients with a recorded preferred place of death (odds ratio [OR] 34; 95% CI 15-77; p < 0.001) and specialist palliative care involvement (OR 7; 95% CI 3-19; p < 0.001). For 66.5% of patients (111/167) anticipatory medications were recorded as being prescribed as part of a single end-of-life planning intervention.ConclusionThe variability in the timing of prescriptions highlights the challenges in diagnosing the end-of-life phase and the potential risks of prescribing far in advance of possible need. Patient and family views and experiences of anticipatory medication care, and their preferences for involvement in prescribing decision-making, warrant urgent investigation.

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