‘I need policymakers to listen’: a stakeholder needs assessment concerning anticipatory injectable medication systems, using a novel qualitative survey

Abstract Background Anticipatory injectable medications for symptom control are a key end-of-life care intervention. However, ensuring their safe and timely use in the community is a global challenge. The needs and priorities of stakeholders involved in processes for prescribing and administering these medications remain underexplored. We must understand these perspectives to design inclusive and adaptive systems. Aim To identify the needs and priorities of key stakeholders involved in community-based systems for using anticipatory injectable medications. Design We adopted a qualitative exploratory design, using an online survey between September and October 2024. Participants provided anonymised demographic information and completed up to four prompts capturing their stakeholder role, needs and priorities. Data were analysed using a combined inductive–deductive framework to produce synthesised shortlists of priorities and needs. Setting/participants UK-based professional and public participants were recruited through social media, professional networks, charities, and public engagement events. Results In total, 439 participants contributed 729 responses across various stakeholder groups. Findings revealed substantial diversity in stakeholder needs and priorities, both within and between groups. However, most stakeholder groups prioritised timely care, minimising of suffering, and wanted nationally consistent guidance for using injectable medications. Broader societal influences also shaped responses. Conclusions Our findings highlight wide diversity in priorities and needs between stakeholders for using anticipatory injectable medications in the community. We propose that inclusive system design should include comprehensive assessment of key stakeholders’ needs and priorities, with the aim of providing better care. Our study demonstrates that stakeholder needs assessment offers a valuable framework to achieve this. What is already known about the topic? Anticipatory injectable medications are a widely used intervention in several countries to support timely end-of-life symptom control at home. There are ongoing challenges with delays, inconsistent access, and variations in prescribing and governance across regions, indicating that system design influences both timeliness and safety. Existing research has primarily focused on the needs of individual professional groups, and no prior work has mapped the differing needs of all stakeholders involved in these systems. What this paper adds? Our study demonstrates that stakeholder groups have diverse needs but most share some core priorities -timely care, national consistency in practice guidance, and minimising suffering. Wider societal factors and concerns shape stakeholder expectations of end-of-life medication systems. Our approach to stakeholder needs assessment reveals system requirements that consensus-based or single-perspective approaches often overlook. Implications for practice, theory, or policy System improvements should be tailored to the specific needs of key stakeholder groups rather than assuming uniform priorities. Strong cross-stakeholder support exists for national, practical guidance on anticipatory prescribing, equipment, training, and governance. Stakeholder needs assessment offers a useful method for designing safer, more responsive end-of-life medication systems.