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Mapping end-of-life and anticipatory medications in palliative care patients using a longitudinal general practice database

Published online by Cambridge University Press:  10 March 2021

H. Khalil Open the ORCID record for H. Khalil [Opens in a new window] ,
M. Garett ,
A. Byrne ,
P. Poon ,
K. Gardner ,
D. Azar ,
L. Craig  and
L. Karimi
H. Khalil*
Affiliation:
Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
M. Garett
Affiliation:
Gippsland Primary Health Network, Traralgon, Victoria, Australia
A. Byrne
Affiliation:
Gippsland Palliative Care Consortium, Warragul, Victoria, Australia
P. Poon
Affiliation:
Monash Health, the Supportive and Palliative Care Unit, Clayton, Victoria, Australia
K. Gardner
Affiliation:
Outcome Health, Blackburn, Victoria, Australia
D. Azar
Affiliation:
Gippsland Primary Health Network, Traralgon, Victoria, Australia
L. Craig
Affiliation:
Gippsland Primary Health Network, Traralgon, Victoria, Australia
L. Karimi
Affiliation:
Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
*
Author for correspondence: Hanan Khalil, A/Professor, Department of Public Health, La Trobe University, Melbourne, Victoria, Australia. E-mail: h.khalil@latrobe.edu.au
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Abstract

Objective

End-of-life and anticipatory medications (AMs) have been widely used in various health care settings for people approaching end-of-life. Lack of access to medications at times of need may result in unnecessary hospital admissions and increased patient and family distress in managing palliative care at home. The study aimed to map the use of end-of-life and AM in a cohort of palliative care patients through the use of the Population Level Analysis and Reporting Data Space and to discuss the results through stakeholder consultation of the relevant organizations.

Methods

A retrospective observational cohort study of 799 palliative care patients in 25 Australian general practice health records with a palliative care referral was undertaken over a period of 10 years. This was followed by stakeholders’ consultation with palliative care nurse practitioners and general practitioners who have palliative care patients.

Results

End-of-life and AM prescribing have been increasing over the recent years. Only a small percentage (13.5%) of palliative care patients received medications through general practice. Stakeholders’ consultation on AM prescribing showed that there is confusion about identifying patients needing medications for end-of-life and mixed knowledge about palliative care referral pathways.

Significance of results

Improved knowledge and information around referral pathways enabling access to palliative care services for general practice patients and their caregivers are needed. Similarly, the increased utility of screening tools to identify patients with palliative care needs may be useful for health care practitioners to ensure timely care is provided.

Keywords

Anticipatory medicationsGeneral practiceLongitudinalPalliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 1 , February 2022 , pp. 94 - 100
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

REFERENCES

Back, AL (2020) Patient-clinician communication issues in palliative care for patients with advanced cancer. Journal of Clinical Oncology 38(9), 866–876.CrossRefGoogle ScholarPubMed
Baker, H, Dargan, S and Smith, C (2019) 46 Improving the prescription of anticipatory medications for adults recognised as dying in a district general hospital. BMJ Supportive & Palliative Care 9(Suppl 1), A26.Google Scholar
Bowers, B and Redsell, SA (2017) A qualitative study of community nurses’ decision-making around the anticipatory prescribing of end-of-life medications. Journal of Advanced Nursing 73(10), 2385–2394.CrossRefGoogle ScholarPubMed
Bowers, B, Ryan, R, Kuhn, I, et al. (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.CrossRefGoogle ScholarPubMed
Braun, V and Clarke, V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2), 77–101.CrossRefGoogle Scholar
Bullen, T, Rosenberg, JP, Smith, B, et al. (2015) The use of emergency medication kits in community palliative care: An exploratory survey of views of current practice in Australian home-based palliative care services. American Journal of Hospice and Palliative Medicine 32(6), 581–587.CrossRefGoogle ScholarPubMed
Faull, C, Windridge, K, Ockleford, E, et al. (2013) Anticipatory prescribing in terminal care at home: What challenges do community health professionals encounter? BMJ Supportive & Palliative Care 3(1), 91–97.CrossRefGoogle ScholarPubMed
Finucane, AM, Stevenson, B, Gardner, H, et al. (2014) Anticipatory prescribing at the end of life in Lothian care homes. British Journal of Community Nursing 19(11), 544–547.CrossRefGoogle ScholarPubMed
Johnstone, L (2020) Facilitating anticipatory prescribing in end-of-life care. Evaluation 14(47), 19.Google Scholar
Kemp, L, Holland, R, Barclay, S, et al. (2012) Pre-emptive prescribing for palliative care patients in primary care. BMJ Supportive & Palliative Care 2(Suppl 1), A2.CrossRefGoogle Scholar
Khalil, H, Poon, P, Byrne, A, et al. (2019a) Challenges associated with anticipatory medications in rural and remote settings. Journal of Palliative Medicine 22(3), 297–301.CrossRefGoogle Scholar
Khalil, H, Poon, P, Byrne, A, et al. (2019b) Medication safety challenges in the palliative care setting: Nurses’ perspectives. Collegian 26(6), 640–644.CrossRefGoogle Scholar
Khalil, H, Byrne, A and Ristevski, E (2019c) The development and implementation of a clinical skills matrix to plan and monitor palliative care nurses’ skills. Collegian 26(6), 634–639.CrossRefGoogle Scholar
Khalil, H, Downie, A and Ristevski, E (2020) Mapping palliative and end of care research in Australia (2000–2018). Palliative & Supportive Care 18(6), 713–721.CrossRefGoogle Scholar
Le, B, Eastman, P, Vij, S, et al. (2017) Palliative care in general practice: GP integration in caring for patients with advanced cancer. Australian Family Physician 46(1/2), 51.Google ScholarPubMed
Leach, C (2019) Nausea and vomiting in palliative care. Clinical Medicine 19(4), 299.CrossRefGoogle ScholarPubMed
Masman, AD, van Dijk, M, Tibboel, D, et al. (2015) Medication use during end-of-life care in a palliative care centre. International Journal of Clinical Pharmacy 37(5), 767–775.CrossRefGoogle Scholar
Milton-White, S and Linhartova, L (2018) End of life care in ICU. In Arora, N and Laha, SK (eds.), The Beginner's Guide to Intensive Care. Boca Raton: Taylor and Francis, p. 427.CrossRefGoogle Scholar
Pearce, C, McLeod, A, Rinehart, N, et al. (2019) What a comprehensive, integrated data strategy looks like: The Population Level Analysis and Reporting (POLAR) program. In Ohno-Machado, L & Seroussi, B (eds.), MedInfo. Amesterdam, Netherlands: IOS Press BV, pp. 303–307.Google Scholar
Pocock, LV, Wye, L, French, LR, et al. (2019) Barriers to GPs identifying patients at the end-of-life and discussions about their care: A qualitative study. Family Practice 36(5), 639–643.CrossRefGoogle ScholarPubMed
RACGP (2020) RACGP Aged Care Clinical Guide (Silver Book). 5th ed. Part B. Advance care planning.Google Scholar
Rosenwax, LK, McNamara, BA, Murray, K, et al. (2011) Hospital and emergency department use in the last year of life: A baseline for future modifications to end-of-life care. Medical Journal of Australia 194(11), 570–573.CrossRefGoogle ScholarPubMed
Seeber, AA, Pols, AJ, Hijdra, A, et al. (2019) Advance care planning in progressive neurological diseases: Lessons from ALS. BMC Palliative Care 18(1), 1–10.CrossRefGoogle ScholarPubMed
Staats, K, Tranvåg, O and Grov, EK (2018) Home-care nurses’ experience with medication kit in palliative care. Journal of Hospice & Palliative Nursing 20(6), E1–E9.CrossRefGoogle ScholarPubMed
State of Victoria (2017) Voluntary assisted dying model established ahead of vote in Parliament. [Media release]. Available at: https://www.premier.vic.gov.au/voluntary-assisted-dying-model-established-aheadof-vote-in-parliament/ (verified 18 September 2018).Google Scholar
State of Victoria (2020) Anticipatory medicines. Statewide guidance for Victoria. Available at: https://www.bettersafercare.vic.gov.au/sites/default/files/2020-03/GUIDANCE_Anticipatory%20medicines%20FINAL.pdf (accessed 07 April 2020).Google Scholar
Thorns, A, Ward, D, Parker, G, et al. (2019). 47 Demonstrating safe prescribing at the end of life after the Gosport War Memorial Hospital report: A regional survey of inpatient hospice practice.CrossRefGoogle Scholar
Wagner, E, Patrick, DL, Khandelwal, N, et al. (2019) The influence of multimorbidity on health care utilization at the end of life for patients with chronic conditions. Journal of Palliative Medicine 22(10), 1260–1265.CrossRefGoogle ScholarPubMed
Wiley, J (2016). Anticipatory Prescribing at the End of Life. Essential Practical Prescribing. p. 280.Google Scholar
Wilson, E, Morbey, H, Brown, J, et al. (2015) Administering anticipatory medications in end-of-life care: A qualitative study of nursing practice in the community and in nursing homes. Palliative Medicine 29(1), 60–70.CrossRefGoogle ScholarPubMed
Wilson, E, Seymour, J and Seale, C (2016) Anticipatory prescribing for end of life care in the community: A survey of community nurses in England. Primary Health Care 26(9), 22–27.CrossRefGoogle Scholar
Youens, D, Moorin, R, Harrison, A, et al. (2020) Using general practice clinical information system data for research: The case in Australia. International Journal of Population Data Science 5, 1.CrossRefGoogle ScholarPubMed