Acceptability of supporting lay-carer administration of anticipatory subcutaneous medications at home: a qualitative study using the theoretical framework of acceptability.

BACKGROUND: Globally, evidence indicates that most people prefer to receive care and die at home, provided high-quality care is available. However, systemic and logistical challenges often prevent this outcome. Palliate is a nurse-led intervention aiming to address these barriers, supporting lay-carers in administering end-of-life subcutaneous medications to their loved ones, through training, written guidance, and documentation.

AIM: To explore the perceptions and experiences of patients, carers, and healthcare professionals regarding the acceptability of the Palliate intervention, using the Theoretical Framework of Acceptability (TFA), including perceived barriers and opportunities to its implementation.

METHODS: A qualitative study was conducted using semi-structured interviews with healthcare professionals, patients, carers, and policy-makers, informed by the TFA. Data were analysed thematically using deductive analysis.

RESULTS: Thirty participants, including people with a diagnosis of advanced illness, carers, and a range of healthcare professionals involved in end-of-life care, provided perspectives on the acceptability of the intervention in end-of-life care. Participants described potential benefits, including improved symptom management, reduced waiting times for medication, and increased empowerment for families to support care at home. Concerns were raised about carer burden, emotional responsibility, and the need for professional oversight. Some participants spoke from direct experience of administering or supporting the intervention in practice, providing insights into both its practical value and the challenges of implementation.

CONCLUSION: While the Palliate intervention was generally viewed as acceptable and potentially beneficial, its broader implementation requires careful consideration. Its acceptability was conditional on carers receiving clear training, ongoing professional support, and being able to participate voluntarily. These findings offer new insights into the boundaries of lay caregiving and have implications for the implementation of family-administered end-of-life care within health systems. Further research is needed to evaluate its safety, impact, and feasibility in diverse contexts before wider adoption can be recommended.