Researchers: Emma Helman, Dr. Melissa Fielding, Dr. Ben Bowers, Dr. Rosanna Fennessy
Start date: 15/12/2025
End date: 28/02/2027
Project summary:
A key intervention intended to improve end-of-life care is the use of anticipatory medications, which are routinely prescribed by visiting clinicians to manage distressing symptoms and prevent avoidable hospital admissions. Increasingly used within community care, these medications position nurses as leaders in end-of-life symptom management. However, this is a clinically complex and emotionally burdensome practice. This study aims to understand the factors that influence decisions around timely and appropriate administration of anticipatory medications, and how nurses perceive their role in end-of-life symptom management for dying adults in the community. This project is a secondary qualitative analysis using 15 patient-centred cases with 15 community nurses in the UK.
Project aims:
i. To explore community nurses’ perspectives and experiences when making decisions around the safe, effective, and timely administration of injectable medications for end-of-life symptom control.
ii. To identify individual, team, and system-level factors that influence community nurses’ decision making, and to consider opportunities to improve the administration of injectable medications for patients receiving end-of-life care in community settings.
Research question: What factors shape community nurses’ experiences and decision-making when administering injectable medications to manage end-of-life symptoms?
Project impact:
This study seeks to address the clear gap in empirical research examining how nurses navigate clinical, ethical, professional, and system factors in the decision-making process for using injectable medications. This will provide important insight to inform practice and policy improvements related to safe and effective symptom management in community palliative care.
Further information, references, publications and presentations:
Bowers B, Pollock K, Barclay S. Simultaneously reassuring and unsettling: a longitudinal qualitative study of community anticipatory medication prescribing for older patients. Age Ageing [Internet]. 2022 Dec 1 [cited 2026 Jan 22];51(12):afac293. Available from: https://doi.org/10.1093/ageing/afac293
Bowers B, Antunes BCP, Etkind S, Hopkins SA, Winterburn I, Kuhn I, et al. Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017. 2023 May 26 [cited 2026 Jan 9]; Available from: https://www.repository.cam.ac.uk/handle/1810/348737
Wilson E, Morbey H, Brown J, Payne S, Seale C, Seymour J. Administering anticipatory medications in end-of-life care: A qualitative study of nursing practice in the community and in nursing homes. Palliat Med [Internet]. 2015 Jan [cited 2026 Jan 9];29(1):60–70. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4266693/