Pre-emptive prescription of medications for the management of potential, catastrophic events in patients with a terminal illness: A survey of palliative medicine doctors:

Background:Distressing and potentially life-threatening events, such as significant external bleeding, may occur in patients with a known terminal condition. These events are often referred to as catastrophic or crisis events. Pharmacological management varies and there is little evidence to guide practice.Aim:The aim of this study was to explore Australasian palliative medicine doctors’ approaches to pre-emptive prescription of medications to manage catastrophic events.Design:Anonymous survey data were collected electronically.Setting/Participants:Australian and New Zealand palliative medicine fellows and trainees were surveyed.Results:Surveys were completed by 121 doctors; 108 (89.2%) who care for adult patients only and 13 (10.8%) who care for paediatric patients or paediatric and adult patients. In all, 74 (61.2%) respondents pre-emptively prescribed medications at least five times per year, and most orders were never administered. Significant visible bleeding and severe, acute airway obstruction were...