Research spotlight: Improving access to medicines at the end of life

Medications prescribed ‘just-in-case’ play an important role in making sure distressing symptoms can be relieved quickly, and at any time, at the end of a person’s life. 

Patient with a walking frame and a carer

More people are living and dying in care homes than ever before. Care home residents are increasingly older – in Scotland, where our team are based, 50% of residents are aged 85 and over.

What’s more, we know that the UK population is continuing to grow. And that means more people will need care at the end of their lives.

The case for ‘just-in-case’

High-quality care depends on making sure the right medications are available the moment people need them. This means prescribing medicines to people with a terminal illness before the onset of common symptoms, such as pain, breathlessness, anxiety, respiratory secretions or nausea.

This is known as ‘anticipatory prescribing’ – prescribing medicines ‘just in case’, so symptoms like those listed above can be relieved swiftly and without delay.

For residents in care homes, being prepared in this way can improve care and reduce the need for unnecessary hospital admissions.

Understanding the barriers

We need to understand the barriers to anticipatory prescribing in care homes. This is important if we want to make sure people living with terminal illness receive the best care possible.

Research led by Sarah Brand, a Masters in Public Health student at the University of Edinburgh, which Dorothy McArthur (Pharmacist at Marie Curie Hospice, Edinburgh) and I supervised, addresses this question. 

Healthcare professionals, who care for residents in care homes, were asked their thoughts on the challenges of prescribing, dispensing or administering ‘anticipatory’ medicines.

Findings showed that they do recognise the benefits of pre-emptive prescribing.

However, they also identified a number of barriers to anticipatory prescribing, including:

  • out-of-hours doctors often being unfamiliar with the resident and care home staff
  • difficulties storing anticipatory medicines at the care home.
  • high turnover of care home staff and managers
  • communication difficulties where English is not a staff member’s first language
  • lack of confidence in recognising when residents are approaching the end of their life

The findings show that good communication and trust between professionals are essential for making sure medicine is available in a timely fashion. 

Training in palliative care, and tools to help staff identify residents living with terminal illness, are needed to improve symptom management for residents in the last days and weeks of their lives.

This research was presented at the Palliative Care Congress in Glasgow, 9-11 March.