Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
Queen's Nursing Institute, London, UK.
BMJ Support Palliat Care. 2024 Jan 8;13(e3):e612-e623. doi: 10.1136/spcare-2022-004080.
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.
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.
Systematic review and narrative synthesis.
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.
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.
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.
CRD42016052108.
在控制生命末期令人痛苦的症状方面，预先开具注射药物是推荐的做法。2017 年的一项系统评价发现，实践和指导依据的是证据不足。此后，又有大量的额外研究，有必要进行新的综述。
综述自 2017 年以来发表的关于在社区中为生命末期的成年人预先开具注射药物的证据，为实践和指导提供信息。
系统评价和叙述性综合。
从 2017 年 5 月至 2022 年 3 月，检索了 9 个文献数据库，并进行了参考文献、引文和期刊手工检索。使用 Gough 的证据权重框架来评估纳入的研究。
28 篇论文被纳入综合分析。自 2017 年以来发表的证据表明，在英国，针对预期症状的四种药物的标准化处方是常见的；其他国家的实践证据有限。关于药物在社区中使用的频率，数据有限。尽管处方解释不足，家属照顾者还是“接受”了这些处方，他们通常很欣赏能够获得这些药物。关于预先开具处方的临床和成本效益的稳健证据仍然缺乏。
支持预先开具处方实践和政策的证据仍然主要基于医疗保健专业人员的看法，即干预措施令人安心，在社区中提供有效、及时的症状缓解，并防止危机住院。关于最佳药物和剂量范围以及这些处方的有效性，仍存在证据不足的情况。迫切需要调查患者和家属对预先开具处方的体验。
CRD42016052108。
