“Desprescrever” nos Doentes em Fim de Vida: Um Guia para Melhorar a Prática Clínica

Romero, Inês; Braga, Beatriz; Rodrigues, Joana; Rodrigues, Rui; Neto, Isabel Galriça

doi:10.24950/rspmi/revisao/139/1/2018

Cited by 8 publications

(10 citation statements)

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“…Of the patients who underwent antibiotic therapy, 30.4% had a duration of less than or equal to three days due to the occurrence of death (r = 0.595, p <0.001). In this particular subgroup, it would be important to understand whether a clinical benefit with antibiotic administration would be expected or whether symptoms should be palliated and managed with other drugs or approaches, such as the use of opioids to control dyspnea or pain in the case of respiratory infections, the main source of infection in this study [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Antibiotherapy: Factors Associated With Prescription

Campoa¹,

Teixeira²,

Luz³

et al. 2022

Cureus

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IntroductionMost cancer patients spend their last days of life in the hospital, often receiving invasive and non-palliative interventions. These patients are particularly susceptible to infections, which are a major cause of death. The decision to use antimicrobials in a palliative context is difficult, given the lack of guidelines. ObjectivesTo characterize patients who received antimicrobials at the end of life and analyze factors associated with their prescription decisions. MethodsA retrospective analysis of patients who died in the Medical Oncology Service from January to December 2017 was done. In addition, the use of antibiotics in the last 15 days of life was considered. Clinical, therapeutic, and Eastern Corporative Oncology Group Performance Status Scale (ECOG PS) variables were analyzed using SPSS v23. ResultsThere were a total of 116 deaths, of which 48.3% (n = 56) received antimicrobials in their last 15 days of life. The median age of the patients was 64.5 years. Most patients (55.4%) had an ECOG PS 4, of which 82.1% were stage IV tumors. The most frequent tumors were colorectal adenocarcinomas (21.3%), digestive noncolorectal (predominantly gastric or esophageal adenocarcinomas) (20.5%), and invasive breast carcinomas (16.4%). Asthenia (33.6%) and dyspnea (19.8%) were the main complaints, and most patients (55.4%) had respiratory infections. Fever was present in 51.8% of patients on antibiotics and was related to their use (p < 0.001). The use of antimicrobials is also related to higher C-reactive protein (CRP) values (p = 0.015). ConclusionsThe decision to institute antimicrobials at the end of life is related to clinical and analytical aspects suggestive of infection without considering the patient's general condition and the oncological disease's prognosis. Deprescription of antibiotic therapy is not yet a current clinical practice.

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Section: Discussionmentioning

confidence: 99%

End-of-Life Antibiotherapy: Factors Associated With Prescription

Campoa¹,

Teixeira²,

Luz³

et al. 2022

Cureus

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“…Para garantir este direito ao paciente recorre-se a um processo de simplificação, cessação ou descontinuação de fármacos, com o objetivo de minimizar a polifarmácia, os riscos inerentes e otimizar os resultados. Este processo denomina-se desprescrição 12,13,14 .…”

Section: Palavrasunclassified

Desprescrição em idosos: uma revisão da literatura

Silva¹,

Freitas²

2019

Diversitates Int J

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ResumoA segurança da farmacoterapia é essencial para o atendimento de idosos, evitando a polifarmácia inadequada. A desprescrição é um processo de revisão individual dos medicamentos usados por pacientes, que orienta os profissionais a considerar relações desfavoráveis de risco-benefício. Assim, o objetivo do artigo foi revisar a literatura existente relacionando pesquisas clínicas e fatores associados com a desprescrição de medicamentos em idosos. As bases consultadas resultaram em 18 artigos com diferentes tipos de intervenção, metodologia, avaliação pós-intervenção, guias de desprescrição, critérios utilizados e medicamentos descontinuados. Houve proporcionalidade entre os tipos de intervenção, demonstrando que não há um procedimento mais eficaz de descontinuação. Idosos que vivem em locais onde há uma maior estabilidade física e emocional tendem a uma melhor aceitação à desprescrição, assim como a descontinuação gradual se mostrou mais eficiente em polimedicados.Palavras-chave: Desprescrição, Descontinuação, Idosos, Geriatria

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“…End-of-life (EoL) prescription of ABT occurs with high frequency, with data in the literature reaching approximately 90% in the last week of the life of cancer patients in hospitalization [5][6][7][8] and 42% in the last two weeks of life of patients with advanced dementia in nursing homes or other institutions [9].…”

Section: Introductionmentioning

confidence: 99%

“…Despite several studies seeking to assess the use of ABT in EoL, most of the factors that motivate their use are unclear, with most studies referring to the clinician's decision/judgment or in the presence of symptoms of infection or fever/changes in inflammatory parameters [10][11][12]. It is then described that patients with poor performance status, advanced disease stage, and lack of clinical benefit will be good indicators for antimicrobial therapy not to be initiated [5,13]. Several factors to be considered are described in the literature, but it is not established which are the most important in decision-making.…”

Section: Introductionmentioning

confidence: 99%

Factors That Influence the Prescription of Antibiotic Therapy at the End-of-Life: Construction and Validation of a Scale

Campoa¹,

Reis-Pina²

2022

Cureus

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Introduction: End-of-life care is frequently discussed in clinical practice. Non-beneficial treatments and the need for decision-making regarding therapeutic institutions are increasingly addressed. There are no guidelines regarding prescribing or de-prescribing antibiotic therapy at the end of life, which depends on clinical decisions. In this study, we developed a scale to assess the factors influencing clinicians' decisions when prescribing antimicrobial agents.Methods: This is a quantitative, exploratory, and descriptive study. After the literature review, the scale was constructed with an analysis of internal consistency and temporal stability. It was applied online together with a sociodemographic and clinical questionnaire. Statistical analysis of the scale, its construction, and final validation were performed.Results: A total of 196 physicians participated in this study (76.5% female, 78.6% aged <40 years), 60.2% specialists, and 35.7% without palliative care training. Almost all of the participants (89.9%) reported having end-of-life care concerns with a high frequency. In this study, a scale was developed to assess factors associated with the prescription of antibiotic therapy in end-of-life patients. This scale revealed the presence of 3 factors: infection, patient/illness, and symptoms. Together, the three factors explain 57.4% of the clinician's decisions. The factors associated with symptoms were the most predominant in decisionmaking compared to those associated with infection.Conclusions: Among the multiple factors that may influence the institution of antibiotic therapy at the end of life, symptomatic control is the most important factor.

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“Desprescrever” nos Doentes em Fim de Vida: Um Guia para Melhorar a Prática Clínica

Cited by 8 publications

References 0 publications

End-of-Life Antibiotherapy: Factors Associated With Prescription

End-of-Life Antibiotherapy: Factors Associated With Prescription

Desprescrição em idosos: uma revisão da literatura

Factors That Influence the Prescription of Antibiotic Therapy at the End-of-Life: Construction and Validation of a Scale

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