The prescription of injectable anticipatory medications ahead of possible need for last-days-of-life symptom relief is established community practice internationally. Healthcare teams and policy makers view anticipatory medication as having a key role in optimising effective and timely symptom control. However, how these medications are subsequently administered (used) is unclear and warrants detailed investigation to inform interdisciplinary practice and guidance. To identify the frequency, timing and recorded circumstances of the administration of injectable end-of-life anticipatory medications prescribed for patients living at home and in residential care. A retrospective mixed-methods observational study using general practitioner (family doctor) and community nursing held clinical records. Community-based care in two English counties. 167 deceased adult patients (aged 18+) registered with eleven general practitioner practices and two associated community nursing services. These were patients prescribed anticipatory medications, identified from the 30 most recent deaths per practice. Patients died between 1 March 2017 and 25 September 2019, from any cause except trauma, sudden death or suicide. Patient characteristics, anticipatory medication discussions, recorded administration contexts and decision-making, medication details, recorded symptom control and comfort at death were collected from clinical records. Data analysis combined quantitative and qualitative analyses in a mixed methods approach. Anticipatory medications were administered to 59.9 % (100/167) patients, commenced between 0 and 586 days before death (median 3 days). Their usage was similar for patients who died from cancer and non-cancer conditions. Anticipatory medications were almost universally started and titrated by visiting nurses. Eleven patients had medications started between 59 days and 586 days before death for recorded reversible non-end-of-life care conditions. Only 5 % (5/100) of patient records contained detailed accounts of patient participation in decisions to start medications: four were recorded as being reluctant to commence medications but agreed to trial injections to relieve symptoms. Crucially, there was recurrent under-recording of the effectiveness of injectable medications and patient comfort. Prescribed medications were commonly administered by visiting community nurses to help manage last-days-of-life symptoms. However, patient records infrequently referred to the effectiveness of administered medication and perceived patient comfort. Most recorded references to patient and family preferences for involvement in anticipatory medication decision-making and their experiences of care were brief and perfunctory. More detailed information should be routinely recorded in clinical records to enable assessment of the appropriate and effective use of anticipatory medicines and how inter-professional collaboration and services could be developed to provide adequate twenty-four-hour cover. Effectiveness of injectable end-of-life symptom control medications and patient comfort often under-recorded @Ben_Bowers__ @PELi_Cam @TheQNI.

中文翻译：

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在社区中注射药物以应对生命的终结：一项混合方法观察研究


在可能需要缓解临终症状之前注射预期药物处方已成为国际社会的惯例。医疗团队和政策制定者认为预期药物在优化有效和及时的症状控制方面发挥着关键作用。然而，这些药物随后如何给药（使用）尚不清楚，需要进行详细调查，以便为跨学科实践和指导提供信息。确定为在家中和住院护理的患者注射临终预期药物的频率、时间和记录情况。一项使用全科医生（家庭医生）和社区护理的回顾性混合方法观察研究保存了临床记录。英国两个县的社区护理。 167 名已故成年患者（18 岁以上）在 11 家全科医生诊所和 2 家相关社区护理服务机构注册。这些患者接受了预期药物治疗，这些药物是从每次诊所最近发生的 30 例死亡中确定的。患者于2017年3月1日至2019年9月25日期间死亡，死亡原因除外伤、猝死或自杀外。从临床记录中收集患者特征、预期用药讨论、记录的给药背景和决策、用药细节、记录的症状控制和死亡时的舒适度。数据分析采用混合方法将定量和定性分析结合起来。 59.9% (100/167) 的患者在死亡前 0 至 586 天（中位 3 天）开始接受预期药物治疗。它们对于死于癌症和非癌症疾病的患者的用法相似。 预期药物治疗几乎普遍由上门护士启动和滴定。 11 名患者在死亡前 59 天至 586 天之间开始接受药物治疗，记录了可逆的非临终护理状况。只有 5% (5/100) 的患者记录包含患者参与开始药物治疗决定的详细记录：有 4 人记录为不愿意开始药物治疗，但同意尝试注射以缓解症状。至关重要的是，注射药物的有效性和患者舒适度经常被低估。处方药通常由上门社区护士管理，以帮助控制生命最后几天的症状。然而，患者记录很少提及用药的有效性和患者的舒适感。大多数记录的患者和家属参与预期药物决策的偏好及其护理经历都是简短和敷衍的。更详细的信息应定期记录在临床记录中，以便评估预期药物的适当和有效使用，以及如何发展跨专业合作和服务以提供充分的二十四小时覆盖。可注射的临终症状控制药物的有效性和患者舒适度经常被低估@Ben_Bowers__ @PELi_Cam @TheQNI。