Anticipatory Care / Planning and Coordinating Care / Nurses / Health Professionals

Planning ahead for predictable changes and needs

What it is

Related Resources

CareSearch GP Hub - Planning for a home death
palliAGED - Symptoms and Medicines
palliAGED Evidence Summary - Withdrawing Treatment and Deprescribing

Anticipatory care takes a person-centred, proactive, ‘thinking ahead’ approach. Via thorough assessment and discussions, a person’s needs can be anticipated. These needs can be physical, psychosocial, or spiritual. They can be needs of the person with a life-limiting illness and/or their family and carer(s).

Why it matters

Anticipatory care planning is part of preventive care and involves regular monitoring of the person’s condition and their priorities. Appropriate care can then be delivered promptly, and emergencies can be avoided.

In practice

Nurses may discuss with other health professionals important clinical changes they observe or information that patients share with them. Nurses may be involved in the multidisciplinary team care planning discussions. Nurse practitioners may be involved in anticipatory prescribing.

Planning

Anticipatory care planning can start at any stage of a person’s care. It is about understanding the person’s situation and their health conditions and helping them to navigate the care system. Nurses can also help them to make informed choices about their care, place of care and optimising quality of life.

Advance care planning is one part of anticipatory care planning The Advance Project offers a structured approach to initiating advance care planning and palliative care in general practice. Resources and online training are available.

Starting anticipatory care planning for people with life-limiting conditions can be prompted by triggers such as:

complex physical or mental health needs
frequent unscheduled doctor’s appointments or unplanned hospital admissions
carer and family stress
the need for respite care
multicultural needs, including the use of interpreters
people who are housebound or living alone
a polypharmacy review
the recognition that the person is imminently dying.

Visit The Advance Project website

Family conferences

Family conferences or case conferences can help with anticipatory care planning. A family meeting is focussed on the family needs and a case conference centres on the clinical care plan. You can use the palliAGED case conference forms to help plan and run a case conference. See working with families for more.

Visit palliAGED to download palliative care case conference forms

Visit palliAGED to Download Case Conference Forms

Anticipatory prescribing

Anticipatory prescribing is part of anticipatory care. This includes prescribing medication and providing education on what to do/what medication to take when symptom(s) worsen. This may include as-required medication (PRN medication) to manage breakthrough pain, nausea, or agitation. The prescriber will consider the person’s place of care, availability of medications and equipment, and who will be available to manage the medications.

It may also include altering the administration of medication when a person has difficulty swallowing tablets and capsules.

Care plans written so that the person, family, and carers understand them, can help to guide the correct use of as-required (PRN) medication or who to contact for advice or assistance as certain signs or symptoms occur.

Rationalising medications and deprescribing

Rationalising medications or deprescribing can also be part of anticipatory care. This is a process whereby a person’s medicines are reviewed and medicines that have no clear benefit or may cause harm are withdrawn. When death is anticipated in the near future then longer-term benefits or side-effects might be re-evaluated. Deprescribing can reduce the potential for drug interactions and adverse effects, improve function and quality of life or reduce medication errors.