Table 8, Quantitative review protocol: Anticipatory prescribing - Care of Dying Adults in the Last Days of Life

Review question	How effective is anticipatory prescribing at improving comfort in adults in the last days of life compared with prescribing at the bed side?
Population and setting	Adults likely to be entering the last days of life, those important to them and healthcare professionals in all settings where NHS funded care is provided.
Intervention	Anticipatory prescribing of all necessary medications for symptom relief of breathlessness, pain, nausea and vomiting, respiratory secretions, anxiety and agitation available in the home, with sufficient for use over a weekend (plus bank holidays).
Comparison	Usual care (for example prescribing at the bedside).
Exclusions	Drugs outside of end of life symptom management Non-pharmacological treatments Oxygen Studies published prior to 2000.
Outcome	Critical outcomes: Quality of life (as rated by the dying person or those important to them or healthcare professional) Control of specific symptoms (agitation, terminal restlessness, breathlessness, pain, nausea and vomiting, respiratory secretions and anxiety) Important outcomes: Subjective ratings from informal carers on quality of care received. The amount of medication prescribed that is administered. Incidence of prescribed medication misused. Admissions to hospitals for symptom management.
Search strategy	The databases to be searched are Medline, Embase, The Cochrane Library, CINAHL. Studies will be restricted to English language only.
Study design	Systematic reviews of RCTs RCTs Non-randomised comparative studies Exclusions: Cohort Case series Case reports Narrative summaries (including literature reviews)
Population size and directness	No restrictions.
Review Strategy	Appraisal of methodological quality: The methodological quality of each study will be assessed using NICE checklists and the quality of the evidence will be assessed by GRADE for each outcome. Synthesis of data: Meta-analysis will be conducted where appropriate. Data on the following groups will be presented separately, if the evidence allows: Dementia or other cognitive impairment Learning disabilities.

Review question

How effective is anticipatory prescribing at improving comfort in adults in the last days of life compared with prescribing at the bed side?

Population and setting

Adults likely to be entering the last days of life, those important to them and healthcare professionals in all settings where NHS funded care is provided.

Intervention

Anticipatory prescribing of all necessary medications for symptom relief of breathlessness, pain, nausea and vomiting, respiratory secretions, anxiety and agitation available in the home, with sufficient for use over a weekend (plus bank holidays).

Comparison

Usual care (for example prescribing at the bedside).

Exclusions

Drugs outside of end of life symptom management
Non-pharmacological treatments
Oxygen
Studies published prior to 2000.

Outcome

Critical outcomes:

Quality of life (as rated by the dying person or those important to them or healthcare professional)
Control of specific symptoms (agitation, terminal restlessness, breathlessness, pain, nausea and vomiting, respiratory secretions and anxiety)

Important outcomes:

Subjective ratings from informal carers on quality of care received.
The amount of medication prescribed that is administered.
Incidence of prescribed medication misused.
Admissions to hospitals for symptom management.

Search strategy

The databases to be searched are Medline, Embase, The Cochrane Library, CINAHL.
Studies will be restricted to English language only.

Study design

Systematic reviews of RCTs
RCTs
Non-randomised comparative studies

Exclusions:

Cohort
Case series
Case reports
Narrative summaries (including literature reviews)

Population size and directness

No restrictions.

Review Strategy

Appraisal of methodological quality:

The methodological quality of each study will be assessed using NICE checklists and the quality of the evidence will be assessed by GRADE for each outcome.

Synthesis of data:

Meta-analysis will be conducted where appropriate.

Data on the following groups will be presented separately, if the evidence allows:

Dementia or other cognitive impairment
Learning disabilities.

From: Appendix C, Clinical review protocols

Care of Dying Adults in the Last Days of Life.

NICE Guideline, No. 31.

National Clinical Guideline Centre (UK).

London: National Institute for Health and Care Excellence (NICE); 2015 Dec 16.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Table 8Quantitative review protocol: Anticipatory prescribing