Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017.

Autor:	Bowers B; Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK bb527@medschl.cam.ac.uk.; Queen's Nursing Institute, London, UK., Antunes BCP; Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK., Etkind S; Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK., Hopkins SA; Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK., Winterburn I; Department of Psychiatry, Cambridge University, Cambridge, Cambridgeshire, UK., Kuhn I; School of Clinical Medicine, Cambridge University, Cambridge, Cambridgeshire, UK., Pollock K; School of Health Sciences, University of Nottingham, Nottingham, UK., Barclay S; Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK.
Jazyk:	angličtina
Zdroj:	BMJ supportive & palliative care [BMJ Support Palliat Care] 2024 Jan 08; Vol. 13 (e3), pp. e612-e623. Date of Electronic Publication: 2024 Jan 08.
DOI:	10.1136/spcare-2022-004080
Abstrakt:	Background: The anticipatory prescribing of injectable medications is recommended practice in controlling distressing symptoms in the last days of life. A 2017 systematic review found practice and guidance was based on inadequate evidence. Since then, there has been considerable additional research, warranting a new review. Aim: To review the evidence published since 2017 concerning anticipatory prescribing of injectable medications for adults at the end-of-life in the community, to inform practice and guidance. Design: Systematic review and narrative synthesis. Methods: Nine literature databases were searched from May 2017 to March 2022, alongside reference, citation and journal hand-searches. Gough's Weight of Evidence framework was used to appraise included studies. Results: Twenty-eight papers were included in the synthesis. Evidence published since 2017 shows that standardised prescribing of four medications for anticipated symptoms is commonplace in the UK; evidence of practices in other countries is limited. There is limited data on how often medications are administered in the community. Prescriptions are 'accepted' by family caregivers despite inadequate explanations and they generally appreciate having access to medications. Robust evidence of the clinical and cost-effectiveness of anticipatory prescribing remains absent. Conclusion: The evidence underpinning anticipatory prescribing practice and policy remains based primarily on healthcare professionals' perceptions that the intervention is reassuring, provides effective, timely symptom relief in the community and prevents crisis hospital admissions. There is still inadequate evidence regarding optimal medications and dose ranges, and the effectiveness of these prescriptions. Patient and family caregiver experiences of anticipatory prescriptions warrant urgent investigation. Prospero Registration: CRD42016052108. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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