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To understand healthcare professionals' perspectives of what works well and what can be improved in the supply and administration of anticipatory medications at the end of life in the community.
Qualitative interpretive study using focus groups.
Semi-structured focus groups included healthcare professionals with experience of using anticipatory medications, and public contributors with lived experiences of relatives' end-of-life care. Participants' demographic information was elicited in a brief questionnaire. Transcripts were analysed inductively using thematic analysis. Data were collected in September 2022.
Eight focus groups involved 58 UK-based participants. Each group included people with a variety of professional roles from diverse geographical areas, and public contributors with relevant lived experiences.
The administration of anticipatory prescriptions was widely perceived to be a valuable intervention, but extensive operational challenges were identified, with three interconnected themes arising from the data: (a) Communication between healthcare teams; (b) Intuitive documentation; (c) Accessibility of medications. Addressing these challenges was perceived to be onerous, particularly for nurses and families.
Operational barriers to the timely and appropriate administration of anticipatory medications risk were perceived as adversely affecting patient care and patients' and families' experiences.
System-level improvements are needed to streamline care processes and ensure equitable, appropriate, and timely access to end-of-life symptom control medications in the community.
This study adheres to relevant EQUATOR guidelines and follows the appropriate Standards for Reporting Qualitative Research (SRQR).
Our Public and Clinician Advisory Group helped shape questions and commented on findings. Focus groups included public participants with lived experience of end-of-life care in the community.
To explore community nurses' experiences of changes to their roles in palliative and end-of-life care.
An e-survey was followed by focus groups.
Fifty-one community nurses with recent experience of delivering end-of-life care in the United Kingdom completed a survey about changes to their roles. A purposive sample of 35 respondents participated in focus groups exploring these changes in more depth; thematic analysis was used with constant comparison.
As well as two new roles—prescribing and verifying death—many participants talked about a broader expansion of their role, increasing their leadership in making complex end-of-life care decisions with patients and families. Most nurses expressed pride in their new knowledge and skills, and satisfaction with the care they were providing. Yet many also expressed distress that heavy workloads impaired their capacity both to provide good clinical care and to train junior colleagues. The importance of General Practitioner support with complex cases was often highlighted, but accessing such support was sometimes difficult.
While welcoming the opportunity to extend their palliative care roles, many participants indicated experiencing moral distress.
Excessive workloads and patchy medical support threaten the retention of the experienced nurses upon whom community palliative care depends.
Our findings suggest that new and extended palliative care roles are viewed positively by nurses. To be sustainable, these changes require better workload management and consistent medical back-up.
We adhered to relevant EQUATOR guidelines, using the SRQR checklist.
Our Public and Clinician Advisory Group helped shape questions and commented on findings.
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