This post is derived from a selection of the main concepts found within three papers (references listed below) on 'anticipatory prescribing'.
Some explanation may assist. I have duplicated 1. What is current practice? across the domains to suggest that the question needs to be answered for each of the care (knowledge) domains. The same principle applies to the repetition of the attitudinal questions at the individual and group (sociological) level. Person-centredness demands that the patient's views are paramount plus the aggregated responses of the group as a whole.
Perhaps there is a 'drug TIME' too, which operates across all the domains once more, and each variously weighted objectively and subjectively? The concept of control and assessment of control is also critical.
I've placed GP decision-making across both 'individual' domains described as it is as a 'process' and for the patient as 'bedside manner', as also reflected in the GP and healthcare professional's communication with the family.
Clinical effectiveness and observations are likewise span the interpersonal and sciences domains. This is to denote the need to achieve and sustain parity of esteem and integrate physical and mental health care - pastoral and spiritual also.
'Cost' is anchored in the political domain, but clearly there are much wider economic ramifications, both in quality of life, quality of death and the way 'cost' is determined, measured, analysed, evaluated and reported.
For me nursing, medicine, healthcare are most effective when they are anticipatory. Observation, reflection and critical thinking are key. In a way for an individual to be health literate is a preparation for self-care. Although clearly in a general sense of health and well-being; not necessarily being literate with respect to a long-term medical condition.
Hodges' model is an idealisation and the detail is obviously described in the papers listed. The intention below is for readers to gain an appreciation of anticipatory prescribing and the application and scope of Hodges' model.
Taking a larger perspective anticipatory prescribing is part of anticipatory care.
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| @GeriSoc https://twitter.com/GeriSoc/status/1374716732120645632?s=20 |
individual
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INTERPERSONAL : SCIENCES
humanistic ----------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
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group
Anticipatory Prescribing
Reassurance for patient, family & friends
clinical effectiveness
subjective TIME
observation
agitation, distress (mood, anxiety, orientation, communication, identity - self, fear, understanding, mental capacity...)
The patient's spiritual well-being needs are met*.
1. What is current practice?
2. What are the attitudes of patients?
3. What are the attitudes of family carers?
4. What are the attitudes of community healthcare professionals?
[as individuals]
GPs’ discussion with patients
(Advanced care planning - choices)
5. What is its impact on patient comfort and symptom control?
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Anticipatory Prescribing
Physical access to medication and treatment is assured.
clinical effectiveness
objective TIME
observation
remote anticipatory prescribing increased 24 hours availability
(out-of-hours)
The intervention seeks to improve [my] symptom control
pain, nausea and vomiting, agitation, and respiratory secretions.
The Covid-19 pandemic has accelerated the practice of Anticipatory
Prescribing; more terminally ill patients are having end-of-life care at home and in care homes.
1. What is current practice?
New routes of administration
injection, oral, sublingual, or rectal
5. What is its impact on patient comfort and symptom control?
GPs’ decision-making processes
Research:
Systematic review and narrative synthesis
Semi-structured interviews
Web-based survey
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An important intervention in supporting patients and families who wish to have last days of life care at home.
1. What is current practice?
2. What are the attitudes of patients?
3. What are the attitudes of family carers?
4. What are the attitudes of community healthcare professionals?
[collectively]
5. What is its impact on patient comfort and symptom control?
Patient and families’ well-being throughout the end-of-life journey
*There is concord and respect regards patient's spiritual well-being needs.
GPs’ discussion with family
family caregiver administration
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The Independent Review of the Liverpool Care Pathway found that the use
of Anticipatory Prescribing without adequate explanation or
justification led to families being concerned about over-sedation and
the medication hastening death.
1. What is current practice?
5. What is its impact on patient comfort and symptom control?
6. Is it cost-effective?
Revise pharmaceutical regulations to permit repurposing of anticipatory
prescribing medications in care homes, wider community drug access, and
recycling unused medications returned to pharmacies.
Address stock shortages.
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Bowers B, Ryan R, Kuhn I, Barclay S (2019) Anticipatory prescribing of
injectable medications for adults at the end of life in the community: A
systematic literature review and narrative synthesis. Palliative
Medicine 33(2): 160-177 https://doi.org/10.1177/0269216318815796
Antunes B, Bowers B, Winterburn I, Kelly MP, Brodrick R, Pollock K,
Majumder M, Spathis A, Lawrie I, George R, Ryan R, Barclay S. (2020)
Anticipatory prescribing in community end-of-life care in the UK and
Ireland during the COVID-19 pandemic: online survey. BMJ Supportive
& Palliative Care; http://dx.doi.org/10.1136/bmjspcare-2020-002394
Bowers B, Barclay SS, Pollock K, Barclay S (2020) General Practitioners’
decisions about prescribing end-of-life anticipatory medications: a
qualitative study. British Journal of General Practice; 70(699) e731-739
https://doi.org/10.3399/bjgp20X712625
orcid.org/0000-0002-0192-8965
