The importance of interdisciplinary communication in the process of anticipatory prescribing

Abstract

In the UK there has been a widespread introduction of 'anticipatory prescribing' in community based palliative care. This involves general practitioners (GPs) writing prescriptions in anticipation of them being needed and has been encouraged to try to minimise the risk of patients suffering uncontrolled symptoms and distress; a key reason why terminally ill patients are admitted to hospital in contradiction of most people's preferences. This paper presents the findings from an ethnographic study of healthcare professionals across four care homes and four community sites in two regions (East Midlands and Lancashire/South Cumbria) of the UK. Data were collected from a range of community health professionals, resulting in 83 episodes of observation and 72 interviews. Findings highlight how essential good interdisciplinary communication is to the process of anticipatory prescribing and end-of-life care. This study found that when interdisciplinary communication worked well the anticipatory prescribing process could be carried out smoothly, optimising patient care.

Managing Medicines for Patients Dying at Home: A Review of Family Caregivers' Experiences

“…GPs have been reported to be resistant to writing prescriptions when they were not reassured that they would be implemented correctly by community nurses. 61 Again, this raises issues about the expectations and responsibilities placed on FCGs when HCPs themselves struggle with these aspects of care provision and working out a viable professional division of labor.…”

How do professionals assess the quality of life of children with advanced cancer receiving palliative care, and what are their recommendations for improvement?

“…This can be problematic in an interdisciplinary work context where common goals are at the heart of the intervention. These aspects further highlight the importance of communication within teams so that individual perceptions can be shared and disparities identified and resolved [ 36 ]. As in assessing pain and emotional distress, the introduction of a formal assessment of QoL - which remains to be developed - could provide a framework for practice that promotes better communication among professionals and with the family [ 37 ].…”

“…In the context of PPC, care must be coordinated among the various parties involved with the child and his/her family to enable personalized care for the child [ 4 ]. In line with this principle, communication within the multidisciplinary team is at the forefront of the improvement areas mentioned [ 36 ]. Professionals consider that communication within the health care team is essential in order to reach an agreement regarding the child’s QoL, beyond the notes that are on file.…”

“…Thus, considering that professionals from diverse professions tend to focus their approach on different areas of QoL, holding interdisciplinary meetings is a way of gaining a more complete and shared understanding of the child’s QoL. It also helps ensure the coherence of the content of their conversations when discussing care objectives with families [ 4 , 36 ].…”

The lessons of Gosport for nursing education

“…Their job is to challenge and question these 'positions' and to refuse to adopt any actions or inactions that may cause patients harm or death. There is no problem per se with the 'anticipatory prescribing' described in the Panel's report (Gosport, 2018) and nurses' valuable role in this(Wilson et al, 2014;Wilson and Seymour, 2017). There is a huge problem with nurses taking on roles and responsibilities for which they are woefully unprepared.…”