Researchers: Dr Ben Bowers, Dr Louisa Polak, Joodi Mourhli, Dr Rosanna Fennessy, Dr Sioned Gwyn (Swansea University), Dr Isabel Hope, Dr Joy McFadzean (Cardiff University), Dr Sarah Yardley (University College London) Stuart Hellard (Cardiff University), Prof. Andrew Carson-Stevens (Cardiff University), Prof. Kristian Pollock (University of Nottingham), Prof. John Clarkson (Department of Engineering, University of Cambridge), Prof. Stephen Barclay.
Funders: Wellcome Trust Early Career Award [Ben Bowers]. NIHR Applied Research Collaboration Affiliated Study
Partner institutions: Engineering Department, University of Cambridge; Cardiff University; University of Nottingham; University College London; Cambridgeshire and Peterborough NHS Foundation Trust; Swansea University
Start date: 16/01/2023
End date: 15/01/2027
Project summary:
This interdisciplinary project seeks to understand the human and system factors involved in the safe, effective and timely use of injectable end-of-life symptom control medications for adults dying at home. We are advancing an inclusive design research methodology and identify with stakeholders where and how systems for using injectable medications can be improved.
Methods: Drawing on engineering, patient safety and social science disciplines, we will use innovative systems-driven inclusive design methods to examine the human and system factors involved in the use of injectable end-of-life medications; where and how this complex adaptive system can be improved will be investigated through three sequential stages.
Stage 1. Mixed-methods analysis of reported patient safety incidents occurring in England and Wales using the National Reporting and Learning System (NRLS) database.
Stage 2. Longitudinal patient-centred case studies exploring the views, experiences and interactions of patients prescribed medications, their family caregivers and clinicians.
Stage 3. Stakeholder focus groups with patients, family caregivers and healthcare teams exploring key issues, generating further knowledge of systems for using medications and how these can be improved.
Analysis (Stages 1 and 2) and fieldwork (Stage 3) are currently underway.
Project aims:
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To understand the human and system factors involved in the safe, effective and timely use of injectable end-of-life symptom control medications at home.
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To identify with patients, family caregivers and healthcare teams were and how systems for using injectable medications can be improved.
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To advance a systems-driven inclusive design methodology by applying it to a specific clinical context.
Project impact:
We will pilot and share a range of innovative interdisciplinary research methods to advance understanding of complex problems and co-designed solutions in primary care. We will provide new knowledge and insights into the systems in place to use injectable medication, highlighting priority areas for improving practice. This evidence will directly inform adaptions in current systems for using injectable medications across the United Kingdom and internationally.
Further information, references, publications and presentations:
Wellcome Early Careers Award Project (Dr Ben Bowers) Enhancing Anticipatory Prescribing in End of Life Care Research Repository. 2024.
Madden B, Bowers B. Sorted: an experimental interpretive poetry piece on injectable medications care at the end of life. Journal of Research in Nursing 2025; Online First.
Bowers B, Gwyn S, Yardley S, Hellard S, Clarkson J, McFadzean IJ, Pollock K, Barclay S, Carons-Stevens A. Learning from end-of-life injectable medication patient safety incidents in the community: a mixed-methods analysis. British Journal of General Practice 2025; Online First
Bowers B, Bashford T. ‘Make do and mend’: redefining resilience within community healthcare. British Journal of Community Nursing 2025 Aug 2;30(8):364-6.
Bowers B, Pollock K, Barclay S. Administration of end-of-life drugs by family caregivers during covid-19 pandemic. British Medical Journal 2020; 369: m1615
Bowers B, Pollock K, Wilkerson I, Massou E, Brimicombe J, Barclay S. Administering injectable medications prescribed in the anticipation of the end of life in the community: A mixed-methods observational study. International Journal of Nursing Studies 2024; Online First
Bowers B, Antunes BCP, Etkind S, Hopkins S, Winterburn I, Kuhn I, Pollock K, Barclay S. Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017. BMJ Supportive & Palliative Care 2023; Online First
Bowers B, Pollock K, Barclay S. Simultaneously reassuring and unsettling: a longitudinal qualitative study of community anticipatory medication prescribing for older patients. Age and Ageing 2022. 51(12): afac293