Antibiotic use towards the end of life: development of good practice recommendations

Seaton, R Andrew; Cooper, Lesley; Fairweather, Jack; Fenning, Stephen; Ferguson, Libby; Galbraith, Susan J; Duffy, Tony; Sneddon, Jacqueline

doi:10.1136/bmjspcare-2020-002732

Cited by 8 publications

(6 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The limitations of the study include the fact that we excluded all individuals who died in 2017. This could bias our results as a high use of antibiotics in the end-of-life stage has been observed [24]. At the same time, these individuals often have less exposure time in general practice due to frequent hospital admissions.…”

Section: Discussionmentioning

confidence: 95%

Sociodemographic characterisation of antibiotic heavy users in the Danish elderly population

Jensen

Aabenhus

Holzknecht

et al. 2022

Scand J Public Health

View full text Add to dashboard Cite

Aims: The development of effective interventions to reduce inappropriate use of antibiotics in the elderly population requires knowledge on who can benefit from such interventions. Thus, we aimed to identify and characterise antibiotic heavy users among elderly patients in general practice with respect to sociodemographic variables. Methods: We conducted a retrospective nationwide register-based study on all Danish elderly citizens (⩾65 years) who redeemed an antibiotic prescription in 2017. Heavy users were defined as the 10% with the highest excess use, that is, their recorded use minus the average use for their sex, age group and comorbidity level as estimated from a linear regression model. Comparative analyses of sociodemographic characteristics (civil status, employment status, urbanity, educational level and country of origin) of heavy users and non-heavy users were performed using logistic regression models. Results: The study population consisted of 251,733 elderly individuals, who in total redeemed 573,265 prescriptions of antibiotics. Heavy users accounted for 68% of all excess use of antibiotics. In multivariable analyses, individuals with an educational level above basic schooling, non-retired, residing in an urban municipality and being born in a country outside Scandinavia all had lower odds of being a heavy user. Widowed, divorced or single individuals had higher odds of being a heavy user compared with married individuals. Relative importance analyses showed that civil status and educational level contributed considerably to the explained variance. Conclusions: This study found an association between sociodemographic characteristics and risk of being a heavy user, indicating that sociodemographic variation exists with regard to antibiotic prescribing.

show abstract

Section: Discussionmentioning

confidence: 95%

Sociodemographic characterisation of antibiotic heavy users in the Danish elderly population

Jensen

Aabenhus

Holzknecht

et al. 2022

Scand J Public Health

View full text Add to dashboard Cite

show abstract

“…Shared decision-making is considered a recommended practice for making antimicrobial-prescribing decisions during the end-of-life. 3 , 10 Discussions surrounding patients’ goals of care can create opportunities for patients to make informed decisions about and contribute to their care, which has potential to alleviate provider challenges, as well as improve build patient trust.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 6 , 8 It has been well documented in the literature that practice recommendations for antimicrobial-prescribing at end-of-life should involve shared decision-making. 3 , 10 Specifically, joint discussions between healthcare providers and the patient/support caregiver regarding antimicrobial-prescribing, including their potential risks and benefits, as well as understanding the patient’s goals are key. 11 However, there is limited data on barriers and facilitators to incorporating antimicrobial-prescribing discussions into shared decision-making conversations.…”

Section: Introductionmentioning

confidence: 99%

Improving shared decision-making around antimicrobial-prescribing during the end-of-life period: a qualitative study of Veterans, their support caregivers and their providers

Goedken,

Balkenende,

Livorsi

et al. 2024

ASHE

View full text Add to dashboard Cite

Objective: Antimicrobials are frequently used for palliation during end-of-life care, but adverse effects, such as antimicrobial resistance, are a concern. Shared decision-making is beneficial in end-of-life care conversations to help align antimicrobial-prescribing with patient preferences. However, there is limited data regarding optimal incorporation of antimicrobial-prescribing discussions into shared decision-making conversations. We explored healthcare provider, patient, and support caregiver (eg, family member/friend) perceptions of barriers and facilitators to discussing antimicrobial-prescribing during the end-of-life period. Design: Qualitative study. Participants: Healthcare providers; palliative care/hospice care patients/caregivers. Methods: We conducted semi-structured interviews on shared attitudes/beliefs about antimicrobial-prescribing during end-of-life patient care at one acute-care and one long-term-care facility. Interviews were analyzed for thematic content. Results: Fifteen providers and 13 patients/caregivers completed interviews. Providers recognized the potential benefit of leveraging shared decision-making to guide antimicrobial-prescribing decisions. Barriers included limited face-to-face time with the patient and uncertainty of end-of-life prognosis. Patients/caregivers cited trust, comprehension, and feeling heard as important characteristics which act as facilitators in fostering effective shared decision-making around antimicrobial use. Communication in which providers ensure patients are involved in shared decision-making discussions could be increased to ensure patients and their providers develop a mutually agreeable care plan. Conclusions: Shared decision-making is a practice that can guide antimicrobial-prescribing decisions during end-of-life care, thus potentially minimizing antimicrobial-related adverse effects. Our findings highlight opportunities for increased shared decision-making around antimicrobial use during end-of-life care. Interventions designed to address the identified barriers to shared decision-making have the potential to improve antimicrobial-prescribing practices at end-of-life.

show abstract

“…In a paper that presented the development of good clinical practice recommendations for AT at the end of life, Seaton et al 25 noted that these recommendations should focus on three principal topics: partnership in future-related decision making, agreement on the goals and limits of treatment, and an ongoing monitoring of any AT that the patient receives. These recommendations justify the need for urgent action to increase awareness of advanced directives in the general population in Israel.…”

Section: Discussionmentioning

confidence: 99%

Physicians' Views and Knowledge on the Antibiotic Treatment of Pneumonia in Advanced Dementia

Harpaz,

Punchik,

Freud

et al. 2024

Preprint

View full text Add to dashboard Cite

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.

show abstract

Antibiotic use towards the end of life: development of good practice recommendations

Cited by 8 publications

References 16 publications

Sociodemographic characterisation of antibiotic heavy users in the Danish elderly population

Sociodemographic characterisation of antibiotic heavy users in the Danish elderly population

Improving shared decision-making around antimicrobial-prescribing during the end-of-life period: a qualitative study of Veterans, their support caregivers and their providers

Physicians' Views and Knowledge on the Antibiotic Treatment of Pneumonia in Advanced Dementia

Contact Info

Product

Resources

About