Just-in-case medications for end of life care

Distressing symptoms are common in the last days of life and their management needs prompt administration of medications delivered by injection because at this time a person can no longer swallow tablet or liquid medications. Anticipatory prescribing or just-in-case medications for symptom management are recommended by NICE as good practice but there is little research evidence about this.

Our research as talked with health professionals and with bereaved families about these experiences  and found that this is can be a very complex process both practically and emotionally.

A summary of the research with family members can be seen here.

The key messages for practice are:

1.     Practitioners need to anticipate that family may:

  • Realise for the first time that their loved one is going to die

  • Think that they are dying now (this may not be true)

  • Think these drugs actually end life (this is not their intention)

Anticipatory communication around these three areas is very important to avoid misunderstandings and help people with their concerns and distress.

2.     Family need more guidance about looking after a sick and dying person.  This should include offering opportunities to discuss:

  • What commonly happens as a person enters the last days of life and what dying is like

  • What symptoms people may have and what medications can do to help

  • When and who to ask for help


3.     Explain what to do with the medications after the person has died.


C Faull, A Pilsworth, K McEvoy, H Hughes, A Patterson. A mixed methods exploratory study of family experiences of anticipatory injectable medicines at home: “It’s a really good idea but it’s just implementing it” medRxiv 2022.06.29.22276695 (pre-print) doi:10.1101/2022.06.29.22276695

Faull C, Windridge K, Ockleford E, Hudson. Anticipatory prescribing in terminal care at home: what challenges do community health professionals encounter? BMJ Supportive and Palliative Care 2013: 3:91-97

Pollock K, Wilson E, Caswell G, Latif A, Caswell A, Avery A, Anderson C, Crosby V, Faull C. Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study. Southampton (UK): NIHR Journals Library; 2021 Aug. PMID: 34410684.

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