• Christine A Hirsch, John F Marriott, and Christina M Faull.
• College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. C.A.Hirsch@bham.ac.uk
• Palliat Med. 2013 Sep 1;27(8):732-8.

BackgroundThe evidence supporting pharmacological treatment of death rattle is poor; yet, anticholinergic drugs feature in end-of-life care pathways and guidelines worldwide as a treatment option.AimThis qualitative arm of a wider study aimed to explore important issues which health-care professionals associated with decision-making to prescribe or administer anticholinergics at the end of life.DesignAfter purposive sampling, five focus groups were conducted. Discussions were audiotaped and transcribed verbatim.SettingThirty medical and nursing personnel working in inpatient and community settings from two specialist palliative care units in the United Kingdom took part in the study.ResultsThematic analysis of transcripts from audiotapes revealed perceived pressures to prescribe and/or administer anticholinergics from colleagues and carers, and drugs were often prescribed or administered in order to be seen to 'do something', although the benefit in terms of therapeutic response was considered minimal. Familiarity with drug regimens and dosing was often based on personal experience. The monitoring of side effects of anticholinergics at the end of life was recognised as problematic and had little influence on prescribing and administration. There was also an indication that patients and carers in the community were more likely to receive timely verbal preparation and explanation around death rattle than those cared for in an inpatient setting.ConclusionThe study raises questions about the routine inclusion of anticholinergic treatment in UK end of life care pathways for the treatment of death rattle.

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