Queen's Nurse, NIHR School for Primary Care Research PhD student.
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge.
Br J Gen Pract. 2020 Oct 1;70(699):e731-e739. doi: 10.3399/bjgp20X712625. Print 2020 Oct.
GPs have a central role in decisions about prescribing anticipatory medications to help control symptoms at the end of life. Little is known about GPs' decision-making processes in prescribing anticipatory medications, how they discuss this with patients and families, or the subsequent use of prescribed drugs.
To explore GPs' decision-making processes in the prescribing and use of anticipatory medications for patients at the end of life.
A qualitative interview study with GPs working in one English county.
Semi-structured interviews were conducted with a purposive sample of 13 GPs. Interview transcripts were analysed inductively using thematic analysis.
Three themes were constructed from the data: something we can do, getting the timing right, and delegating care while retaining responsibility. Anticipatory medications were a tangible intervention GPs felt they could offer patients approaching death (something we can do). The prescribing of anticipatory medications was recognised as a harbinger of death for patients and their families. Nevertheless, GPs preferred to discuss and prescribe anticipatory medications weeks before death was expected whenever possible (getting the timing right). After prescribing medications, GPs relied on nurses to assess when to administer drugs and keep them updated about their use (delegating care while retaining responsibility).
GPs view anticipatory medications as key to symptom management for patients at the end of life. The drugs are often presented as a clinical recommendation to ensure patients and families accept the prescription. GPs need regular access to nurses and rely on their skills to administer drugs appropriately. Patients' and families' experiences of anticipatory medications, and their preferences for involvement in decision making, warrant urgent investigation.
全科医生在决定开具缓解临终症状的预嘱药物方面发挥着核心作用。但对于全科医生在开具预嘱药物方面的决策过程、与患者和家属的讨论方式以及随后开具药物的使用情况，人们知之甚少。
探讨全科医生在为临终患者开具和使用预嘱药物方面的决策过程。
在英格兰一个县的全科医生中进行了一项定性访谈研究。
采用目的性抽样，对 13 名全科医生进行了半结构化访谈。使用主题分析对访谈记录进行了归纳分析。
从数据中构建了三个主题：我们可以做的事情、把握时机和在保留责任的同时委托护理。预嘱药物是全科医生认为可以为接近死亡的患者提供的一种切实可行的干预措施（我们可以做的事情）。尽管如此，全科医生仍倾向于在预计患者死亡前数周讨论并开具预嘱药物（把握时机）。开具药物后，全科医生依靠护士评估何时给药，并让他们了解药物的使用情况（在保留责任的同时委托护理）。
全科医生认为预嘱药物是临终患者症状管理的关键。这些药物通常被作为一种临床建议来确保患者和家属接受处方。全科医生需要定期获得护士的支持，并依赖他们的技能来正确给药。患者和家属对预嘱药物的体验以及他们对参与决策的偏好，值得紧急调查。
