Determinants of Physicians' Attitudes Toward the Management of Infectious Diseases in Terminally Ill Patients With Cancer

Morioka, Shigefumi; Mori, Masanori; Suzuki, Tomomi; Yokomichi, Marika; Hamano, Jun; Morita, Tatsuya

doi:10.1016/j.jpainsymman.2020.06.041

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…One survey study found that many doctors who provide palliative care tend to initiate and maintain or extend antibiotics use in EOL patients, even in cases where antibiotics might not be appropriate or where the risks might outweigh the benefits [ 4 ]. Another study found that physicians have divergent attitudes toward the management of infectious diseases in terminally ill patients with cancer [ 29 ]. Our survey reveals a significant lack of awareness about ASP among internal medicine residents and specialists, and that doctors found it difficult to use antibiotics appropriately in EOL patients.…”

Section: Discussionmentioning

confidence: 99%

Antibiotics use patterns in end-of-life cancer patients and medical staff’s perception of antimicrobial stewardship programs

Kwon,

Jung,

Choi

et al. 2023

Korean J Intern Med

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Background/Aims: While most cancer patients with end-of-life (EOL) care receive antibiotic treatments, antibiotic use should be decided appropriately considering the benefits, side effects, resistance, and cost effects. Antimicrobial stewardship programs (ASP) are important for patients with EOL care, but there is limited study analyzing actual antibiotic use in EOL care and the perceptions of Korean medical staff.Methods: Electronic medical records of 149 deceased cancer patients hospitalized in the medical hospitalist units at Asan Medical Center in Seoul from May 2019 to September 2021 were reviewed. Basic information, antibiotic use, duration, and changes were investigated. We surveyed medical staff’s perceptions of antibiotics in cancer patients with EOL.Results: Of the 149 cancer patients with EOL care, 146 (98.0%) agreed with physician orders for life-sustaining treatment (POLST). In total, 143 (95.9%) received antibiotics, 110 (76.9%) received combination antibiotic treatment, and 116 (81.1%) were given antibiotics until the day of death. In a survey of 60 medical staff, 42 (70.0%) did not know about ASP, and 24 (40.0%) thought ASP was important in EOL care. Nineteen doctors (31.7%) discussed the use or discontinuation of antibiotics with patients or caregivers when writing POLST, but only 8 patients (5.6%) stopped antibiotics after POLST.Conclusions: Most cancer patients with EOL care continue to receive antibiotics until just before their death. A careful approach is needed, considering the benefits and side effects of antibiotic use, and the patient’s right to self-decision. It is necessary to actively improve awareness of ASP and its importance for medical staff.

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Section: Discussionmentioning

confidence: 99%

Antibiotics use patterns in end-of-life cancer patients and medical staff’s perception of antimicrobial stewardship programs

Kwon,

Jung,

Choi

et al. 2023

Korean J Intern Med

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“…10 Predictors of EOL antimicrobial use are multifactorial and may include: insufficient prescriber knowledge of benefits and risks, a desire to respect patient or surrogate decisions, and beliefs that antimicrobials are less invasive than other therapies or that they palliate symptoms. [11][12][13] To our knowledge, there is no high-level evidence to support antimicrobial use for relief of distressing symptoms, with the exception of pain secondary to urinary tract infection at EOL (prescriptive use poorly defined). 3,4,[14][15][16] Furthermore, when a patient's prognosis is estimated as weeks-to-months, there is little data to support survival benefits, 5,17 and conversely, continued use for those imminently dying may hasten death.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Antimicrobial Use at the End-Of-Life Among Hospitalized Cancer Patients

Pandey

Wisniewski

Morjaria

et al. 2023

Am J Hosp Palliat Care

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Background: Antimicrobials are frequently administered at end-of-life (EOL) and their non-beneficial use may subject patients to unnecessary harms. Studies analyzing factors for antimicrobial prescribing in solid tumor cancer patients at the EOL are lacking. Thus, we aimed to identify factors and patterns associated with antimicrobial use in hospitalized adults with cancer at EOL. Methods: We used a retrospective cohort design to review electronic medical records of terminal hospitalized patients ≥18 years with solid tumors admitted to non-intensive care units in a metropolitan comprehensive cancer center during 2019 and assessed antimicrobial use in the last 7 days of life. Results: Among 633 cancer patients, 59% ( n = 376) received antimicrobials (AM+) within the last 7 days of life. AM + patients were older (P = .012), mostly of male gender (55%), and non-Hispanic ethnicity (87%). AM + patients were significantly more likely to have a foreign device, suspected signs of infection, neutropenia, positive blood culture result, documented advance directive; receive laboratory or radiologic testing, and a palliative care or infectious disease consultation (all P < .05). No statistically significant differences were observed in the presence of documented goals of care discussions, or EOL discussions/EOL care orders. Conclusion: Antimicrobial use at the EOL is common in solid tumor cancer patients at the EOL and is associated with increased utilization of invasive interventions. There is an opportunity for infectious disease specialists to build primary palliative care skills and partner with antimicrobial stewardship programs to better advise patients, decision makers, and primary teams on the use of antimicrobials at the EOL.

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Physicians’ Beliefs and Attitudes Toward Hypoactive Delirium in The Last Days of Life

Oya

Morita

Tagami

et al. 2022

Journal of Pain and Symptom Management

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Determinants of Physicians' Attitudes Toward the Management of Infectious Diseases in Terminally Ill Patients With Cancer

Cited by 4 publications

References 27 publications

Antibiotics use patterns in end-of-life cancer patients and medical staff’s perception of antimicrobial stewardship programs

Antibiotics use patterns in end-of-life cancer patients and medical staff’s perception of antimicrobial stewardship programs

Factors Associated with Antimicrobial Use at the End-Of-Life Among Hospitalized Cancer Patients

Physicians’ Beliefs and Attitudes Toward Hypoactive Delirium in The Last Days of Life

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