#54 Anticipatory Prescribing: what it is, what research tells us and what we can do better with Dr Ben Bowers

In this episode it is my pleasure to talk with Dr Ben Bowers. We talk about Ben’s research focusing on Anticipatory prescribing, the practice he found and what we can learn from this to deliver more personalised care.

Key messages from guest

• Anticipatory prescribing is prescribing injectable medications ahead of time and before they might be needed.

• Ben explains the fear associated with opioids, and how safe effective prescribing does not hasten death.  

• Ben found 56 different names for anticipatory prescribing as part of his research

• Ben sought information from the experiences of nurses, GPs, patients and family and a medical record as part of his research.

• Ben describes the variation in practice he found. 

• Conversations about what the anticipatory medication was and when it could be used was found to be frequently missing.

• Family carers also struggled with their role in symptom assessment and the tension between a professional assessment and hearing family experience of symptoms. 

• The average time between prescribing anticipatory medications and death was 18 days.

• The importance of good assessment underpinning symptom control is highlighted by Ben 

• Lack of understanding Ordinary Dying is common in the UK, and the need for greater understanding or “open awareness” is highlighted by Ben.

• Ben suggests we need to explore people’s concerns and fears about death and dying and have more open conversations about Advance Care Planning - and to re visit these conversations.

  
  

Resources

• Listen to Dr Kathryn Mannix explain Ordinary Dying in episode 32: https://speakforme.co.uk/podcast-episode-32 

• Dr Ben Bowers QN

• Is end-of-life anticipatory prescribing always enough?  

• Dr Ben Bowers collects Outstanding Service Award from Queen’s Nursing Institute 

• Bowers B, Pollock K, Barclay S. Simultaneously reassuring and unsettling: a longitudinal qualitative study of community anticipatory medication prescribing for older patients. Age and Ageing 2022. 51(12): Online First

• Bowers B, Pollock K, Barclay S. Unwelcome memento mori or best clinical practice? Community end-of-life anticipatory medication prescribing practice: a mixed methods observational study. Palliative Medicine 2022; 36(1): 95-104

• Bowers B, Barclay SS, Pollock K, Barclay S. General Practitioners’ decisions about prescribing end-of-life anticipatory medications: a qualitative study. British Journal of General Practice 2020; 70(699) e731-739

• Bowers B, Pollock K, Barclay S. Administration of end-of-life drugs by family caregivers during covid-19 pandemic. British Medical Journal 2020; 369: m1615

• Bowers B, Ryan R, Kuhn I, Barclay S.Anticipatory prescribing of injectable medications for adults at the end of life in the community: A systematic literature review and narrative synthesis. Palliative Medicine 2019; 33(2): 160-177

• Bowers B, Antunes BCP, Etkind S, Hopkins S, Winterburn I, Kuhn I, Pollock K, Barclay S. Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017. BMJ Supportive & Palliative Care 2023. Online First: 26 May 2023

Bio

Ben is a clinical-academic community nurse. He is a Wellcome Post-Doctoral Fellow and practices clinically as an Honorary Nurse Consultant in Palliative Care. Ben is a Queen’s Nurse and was awarded the Queen Elizabeth Award for Outstanding Service in 2022, for outstanding long-term contributions and leadership in advancing community nursing and palliative and end of life care. He also received an NHS England Community Nursing Research Award in 2022. Ben is an Honorary Associate Professor with the University of Nottingham.