Should we refrain from antibiotic use in hospice patients?

Furuno, Jon P.; Noble, Brie N.; Fromme, Erik K.

doi:10.1586/14787210.2016.1128823

Cited by 17 publications

(18 citation statements)

References 15 publications

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“…The decision to treat or not to treat suspected infection in the terminally ill patient is complex and requires an individual approach and ethical considerations. If possible the decision should preferably be taken together with the patient and the relatives, which is a recommendation that aligns with recent publications in the field [ 14 ].…”

Section: Discussionmentioning

confidence: 83%

“…The difficulty of making sound treatment decisions in palliative patients have been addressed in several publications discussing such philosophical and ethical issues [ 11 , 12 , 13 ]. In a recent editorial, Furuno et al argues that decisions on antibiotic use in hospice care should be made on a case-by-case basis and be consistent with the individuals goals of care [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic Treatment in End-of-Life Cancer Patients—A Retrospective Observational Study at a Palliative Care Center in Sweden

Frankling

Bergqvist

Bergman

et al. 2016

Cancers

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Background: The aim of this study was to elucidate whether palliative cancer patients benefit from antibiotic treatment in the last two weeks of life when an infection is suspected. Method: We reviewed medical records from 160 deceased palliative cancer patients that had been included in previous studies on vitamin D and infections. Patients treated with antibiotics during the last two weeks of life were identified and net effects of treatment (symptom relief) and possible adverse events were extracted from medical records. Results: Seventy-nine patients (49%) had been treated with antibiotics during the last two weeks in life. In 37% (n = 29), the treatment resulted in evident symptom relief and among these 50% had a positive bacterial culture, 43% had a negative culture and in 7% no culture was taken. Among the patients with no or unknown effect of antibiotics, 50% had a positive culture. When the indication for antibiotic treatment was to avoid or treat sepsis, symptom relief was achieved in 50% of the patients (n = 19). Only 4% (n = 3) of the patients experienced adverse events of the treatment (diarrhea, nausea). Conclusions: Treating infections with antibiotics in the last weeks of life may improve the quality of life for palliative cancer patients, especially if sepsis is suspected or confirmed. According to our results, the beneficial effects outweigh the potentially negative outcomes.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Antibiotic Treatment in End-of-Life Cancer Patients—A Retrospective Observational Study at a Palliative Care Center in Sweden

Frankling

Bergqvist

Bergman

et al. 2016

Cancers

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“…However, these prescriptions may also result in several challenges for patients and hospice providers. Minimal data exist on the safety and effectiveness for many medications used to manage chronic illnesses (eg, antihypertensives, anticoagulants, glycemic control medications) as well as antimicrobial therapy in hospice . These medications have well‐described side effects and associated adverse events that may be exacerbated in hospice patients .…”

Section: Discussionmentioning

confidence: 99%

Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care

Kadoyama

Noble

Izumi

et al. 2019

J American Geriatrics Society

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OBJECTIVES To quantify the frequency and type of medication decisions on discharge from the hospital to hospice care. DESIGN Retrospective cohort study. SETTING A 544‐bed academic tertiary care hospital in Portland, Oregon. PARTICIPANTS A total of 348 adult patients (age ≥18 y) discharged to hospice care between January 1, 2010, and December 31, 2016. MEASUREMENTS Data were collected from an electronic repository of medical record data and a manual review of patients’ discharge summaries. Our outcomes of interest were the frequency and type of medication decisions documented in patients’ discharge summaries. Medication decisions were categorized as continuation, continuation but with changes in dose, route of administration, and/or frequency, discontinuation, and initiation of new medications. We also collected data on the frequency of patient/family in the participation of medication‐related decisions. RESULTS Patients were prescribed a mean of 7.1 medications (standard deviation [SD] = 4.8) on discharge to hospice care. The most prevalent medications prescribed on discharge were strong opioids (82.5%), anxiolytics/sedatives (62.9%), laxatives (57.5%), antiemetics (54.3%), and nonopioid analgesics (45.4%). However, only 67.8% (213/341) of patients who were prescribed an opioid on discharge to hospice care were also prescribed a laxative. Discharging providers made a mean of 15.0 decisions (SD = 7.2) per patient of which 28.5% were to continue medications without changes, 6.7% were to continue medications with changes, 30.3% were to initiate new medications, and 34.5% were to discontinue existing medications. Patients and/or family members were involved in medication decisions during 21.6% of discharges; patients were involved in 15.2% of decisions. CONCLUSION Patients averaged more than 15 medication decisions on discharge to hospice care. However, it was rarely documented that patients and/or their families participated in these decisions. J Am Geriatr Soc, 2019.

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“…33,37 As each terminally ill older patient may have differing goals, underlying illness and tolerances for uncertainty, there is no single approach regarding the use of antimicrobial agents. 39 However, by physicians, patients, and families assessing goals of care and understanding what treatments entail, care can be aligned with goals.…”

Section: Approach To Decision Making Regarding Antimicrobial Usementioning

confidence: 99%

Design and analysis of longitudinal trials of antimicrobial use at the end of life: to give or not to give?

Juthani‐Mehta

Allore

2019

Therapeutic Advances in Drug Safety

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This perspective review considers analytic features of the design of a longitudinal trial regarding antimicrobial therapy in older terminal cancer patients receiving palliative care. We first overview antimicrobial use at the end of life; both the potential hazards and benefits. Antimicrobial prescribing should consider both initiation as well as cessation of medications when analyzing the burden of medications. Approaches to decision making regarding antimicrobial use are presented and the importance of health literacy in these decision processes. We next present aspects of both feasibility and comparative trial design with a health literacy intervention to reduce antimicrobial use in older terminal cancer patients receiving palliative care. Considerations to clustered randomization and given that infections can reoccur over a trial period, we share suggestions of longitudinal modeling of clustered randomized trial data.

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Should we refrain from antibiotic use in hospice patients?

Cited by 17 publications

References 15 publications

Antibiotic Treatment in End-of-Life Cancer Patients—A Retrospective Observational Study at a Palliative Care Center in Sweden

Antibiotic Treatment in End-of-Life Cancer Patients—A Retrospective Observational Study at a Palliative Care Center in Sweden

Frequency and Documentation of Medication Decisions on Discharge from the Hospital to Hospice Care

Design and analysis of longitudinal trials of antimicrobial use at the end of life: to give or not to give?

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