This study is currently actively recruiting participants. We encourage expressions of interest to be sent to: maida.campbell@esneft.nhs.uk
Researchers: Maida Campbell, Dr Ben Bowers, Joodi Mourhli
Funders: NIHR Applied Research Collaboration East of England Research Fellowship
Partner institutions: East Suffolk and North Essex NHS Foundation Trust
Start date: 23/04/2026
End date: 31/08/2027
Project summary:
More than 500,000 people die each year in the UK. Although the preference for many is to die at home, nearly half die in hospital. Despite the importance of timely symptom control, nurses often experience uncertainty and reduced confidence in administering injectable end-of-life symptom management medications, contributing to inconsistent care and delays in relief for patients. This project explores how ward-based nurses make decisions about administering ‘as required’ injectable medications for symptom management at the end of life in acute hospital settings. By examining nurses’ perspectives and experiences through qualitative interviews, we aim to identify barriers to effective medication use and inform strategies to improve support, confidence, and consistency in end-of-life symptom management within acute hospitals.
Project aims:
Aim:
To explore how ward-based nurses make decisions about administering 'as required' injectable end-of-life symptom management medications, and what support they perceive as helpful for administration.
Objectives:
- To understand nurses’ knowledge and perceptions of anticipatory medications
- To explore decision-making processes, including medication choice and dosing
- To examine communication with patients and families
- To identify barriers and facilitators to administering medications
- To explore cultural and ethical considerations
- To identify training and support needs
Project impact:
This project will provide insights to improve the quality and consistency of end-of-life symptom management in hospital settings by increasing understanding of the factors influencing ward-based nurses’ decisions to administer ‘as required’ injectable medications for symptom management at the end of life. The findings will inform improvements in clinical guidance, education, and workforce support, helping nurses feel more confident and supported in practice. This contributes to more timely symptom relief, reduced variation in care, improved patient and family experiences, and safer, more effective end-of-life care delivery across hospital settings.
Further information, references, publications and presentations:
1. Wilson, E., Seymour, J. and Seale, C. (2016). Anticipatory prescribing for end of life care: a survey of community nurses in England. Primary Health Care, [online] 26(9), pp.22–27. doi:https://doi.org/10.7748/phc.2016.e1151.
2. Faull, C., Windridge, K., Ockleford, E. and Hudson, M. (2012). Anticipatory prescribing in terminal care at home: what challenges do community health professionals encounter? BMJ Supportive & Palliative Care, 3(1), pp.91–97. doi:https://doi.org/10.1136/bmjspcare-2012-000193.
3. Darzi, L. (2024). Independent Investigation of the NHS in England. [online] GOV.UK. Available at: https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england.
4. Staats, K., Jeppestøl, K., Bente Egge Søvde, Bodil Aarmo Brenne and Anett Skorpen Tarberg (2024). End-of-life Care at home: Dignity of Family Caregivers. Nursing Ethics, 32(2). doi:https://doi.org/10.1177/09697330241241773.
5. Bowers, B., Ryan, R., Kuhn, I. and Barclay, S. (2018). Anticipatory prescribing of injectable medications for adults at the end of life in the community: A systematic literature review and narrative synthesis. Palliative Medicine, [online] 33(2), pp.160–177. doi:https://doi.org/10.1177/0269216318815796.
6. Hirsch, C., Hall, E., Shah, F. and Tomas, J. (2022). Attitudes of ward nurses towards the administration of ‘as required’ injectable medications for symptom control at the end of life. International Journal of Palliative Nursing, 28(11), pp.522–530. doi:https://doi.org/10.12968/ijpn.2022.28.11.522.