Physicians’ views and knowledge on the antibiotic treatment of pneumonia in advanced dementia

Abstract

Background Antibiotic treatment (AT) for patients with advanced dementia and pneumonia is a complex issue. AT can prolong life, but it can also prolong suffering for the patient and the family. In this study we evaluated physicians’ attitudes to this issue. Methods A vignette-based survey among community-based physicians (CBP) and hospital-based physicians (HBP) who work in southern Israel. The physicians were asked to complete a questionnaire on their knowledge and attitudes to AT, based on a case description of a patient with advanced dementia and pneumonia. Results 211 physicians participated in the study including 134 CBP (63.5%) and 77 HBP (36.5%). 177 physicians chose the AT option for the patient presented in the case, with 59.7% of the HBP and 32.8% of the CBP choosing intravenous (IV) AT (p = 0.017). In contrast, in the same case, but with themselves as the patient, 68.8% of HBP and 32.8% of CBP chose the option of palliative care without AT, with only 14.3% of HBP and 10.4% of CBP choosing the option of hospitalization with IV AT. In two logistic regression models, physicians who chose IV AT for themselves were fourfold more likely to make a similar choice for their patients. Over 75% of the physicians were not knowledgeable about the administration of AT in accordance with the Dying Patient Act. Conclusions The results of this study indicate the need for an educational intervention among physicians to expand their knowledge and expertise on end-of-life treatment for patients with advanced dementia. In addition, we invite policy makers to convene a discussion on the possibility of changing the law to facilitate the conduct of studies of patients with advanced dementia. Such studies would make it possible to develop an evidence-based treatment strategy.