The impact of palliative care consultation on reducing antibiotic overuse in hospitalized patients with terminal cancer at the end of life: a propensity score-weighting study

Abstract

Objectives A substantial number of hospitalized patients with terminal cancer at the end-of-life phase receive antibiotics, even with imminent death. We evaluated the impact of palliative care consultation on antibiotic use in hospitalized patients with terminal cancer during the end-of-life phase. Methods We identified adult patients with metastatic solid cancer who died at a tertiary medical centre in Seoul, Republic of Korea, following at least 4 days of hospitalization (January 2018–December 2020). Patients were divided into palliative and non-palliative care consultation groups. Propensity score-weighted, multivariable logistic regression analysis was used to compare the proportion of patients receiving antibiotics within 3 days before death between the two groups. Results Among 1143 patients analysed, 940 (82.2%) received antibiotics within 3 days before death. The proportion of patients receiving antibiotics was significantly lower (propensity score-weighted P < 0.001) in the palliative care consultation group (344/468; 73.5%) than in the non-palliative care consultation group (596/675; 88.3%). The decrease in the proportion of patients receiving antibiotics in the palliative care consultation group was significant for a carbapenem (42.4% versus 22.4%; P < 0.001), a glycopeptide (23.3% versus 11.1%; P < 0.001) and a quinolone (30.5% versus 19.4%; P = 0.012). In the multivariable logistic regression analysis, receiving palliative care consultation (adjusted OR 0.46, 95% CI 0.33–0.65; P < 0.001) was independently associated with reduced antibiotic use during the end-of-life phase. Conclusions Palliative care consultation may reduce aggressive antibiotic use in hospitalized patients with terminal cancer during the end-of-life phase.

From Epidemiology of Community-Onset Bloodstream Infections to the Development of Empirical Antimicrobial Treatment-Decision Algorithm in a Region with High Burden of Antimicrobial Resistance

“…All patients with solid tumors who died during the 30-day follow-up period in our study had advanced-stage malignancy. Despite no survival advantage, antibiotics were administered in 82% of patients with terminal cancer within three days of death at an academic hospital in a retrospective study conducted in Korea [20]. Appropriately directed palliative care can reduce aggressive antimicrobial use near the end of life.…”

Preferred versus Actual Place of Care and Factors Associated with Home Discharge among Korean Patients with Advanced Cancer: A Retrospective Cohort Study

“…They also explore the individual’s own preferences and values and conduct goals-of-care discussion and advance care planning for EOL through thorough interview with the patient and caregivers. Then, the team delivers the interview contents and recommendations for palliative care planning to the primary attending physician who makes a referral, facilitating collaborative decision making among all the stakeholders [ 17 , 18 ].…”

Effects of tertiary palliative care on the pattern of end‐of‐life care in patients with hematologic malignancies in Korea

“…The two physicians and a nurse work full‐time in the PC team. The detailed process of PC consultation has been described elsewhere 14 . After a referral from a primary care physician, the team offers a holistic distress assessment to the patients and families and identifies their values and preferences.…”

“…The detailed process of PC consultation has been described elsewhere. 14 After a referral from a primary care physician, the team offers a holistic distress assessment to the patients and families and identifies their values and preferences. The team also facilitates advance care planning (ACP) and shared decision-making among stakeholders by discussing the goals of EOL care with patients and delivering interview content with PC recommendations to primary care physicians.…”