This research will address the significant gaps in current knowledge, investigating the human and system factors involved in the safe, effective and timely use of injectable end-of-life symptom control medications at home.
Background
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. It will advance an inclusive design research methodology and identify with stakeholders where and how systems for using injectable medications can be improved.
This is a Wellcome Trust funded Early Career Award four-year project, led by Dr Ben Bowers and is ARC associated and supported by Prof. Stephen Barclay and the Palliative and End of Life Care Theme.
Project Aims
- 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.
- To identify with patients, family caregivers and healthcare teams were and how systems for using injectable medications can be improved.
- To advance a systems-driven inclusive design methodology by applying it to a specific clinical context.
Project Activity
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.
Anticipated outputs
- In-depth new knowledge concerning 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.
- New knowledge and insights into the systems in place to use injectable medication, highlighting priority areas for improving practice.
Findings will be disseminated via scientific publications, conferences and targeted online briefings and videos for researcher, clinician and policymaker communities.
Who is involved?
- Dr Ben Bowers (PI), University of Cambridge & Cambridgeshire and Peterborough NHS Foundation Trust
- Prof. Stephen Barclay (research sponsor and lead mentor), University of Cambridge
- Prof. Kristian Pollock, University of Nottingham
- Prof. Andrew Carson-Stevens, Cardiff University
- Dr Sarah Yardley, University College London
- Prof. John Clarkson, University of Cambridge.
Resources/ papers
Wellcome Early Careers Award (Dr Ben Bowers)
- 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): Online First
- Bowers B, Pollock K, Barclay S. Unwelcome memento mori or best clinical practice? Community end-of-life anticipatory medication prescribing practice: a mixed methods observational study. Palliative Medicine 2022; 36(1): 95-104
- Bowers B, Barclay SS, Pollock K, Barclay S. General Practitioners’ decisions about prescribing end-of-life anticipatory medications: a qualitative study. British Journal of General Practice 2020; 70(699) e731-739
- Bowers B, Ryan R, Kuhn I, Barclay S. Anticipatory prescribing of injectable medications for adults at the end of life in the community: A systematic literature review and narrative synthesis. Palliative Medicine 2019; 33(2): 160-177
