Wishes of Patients With Terminal Cancer and Influencing Factors Toward the Use of Antibiotics in Taiwan

Yao, Chen; Hsieh, Meng-Yun; Chiu, Tai-Yuan; Hu, Wen‐Yu; Hung, Shou-Hung; Ching-Yu, Chen; Lee, Long‐Teng

doi:10.1177/1049909114540033

Cited by 15 publications

(9 citation statements)

References 22 publications

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“…With regard to the use of artificial nutrition or tube feeding, a Chinese adage says that "hunger breeds discontentment," and accordingly some families may be worried that the patient might die of hunger, and then ask that artificial nutrition or tube feeding is continued for these patients. As for the use of antibiotics in terminally ill patients, previous studies conducted in patients with terminal cancer [34][35][36] and noncancer 22,37 reported that the use of antibiotics for infection was not uncommon. There has been some controversy about decision-making and ethical concerns with antibiotic use in terminally ill patients.…”

Section: Discussionmentioning

confidence: 99%

“…34 Another study reported that 45% of patients with cancer would wish to use antibiotics at a late terminal stage and factors associated with the wish to use antibiotics included familiarity with antibiotics, subjective norms, and attitudes toward the burden of antibiotics. 35 The use of antibiotics in terminal patients requires full discussion and shared decision-making.…”

Section: Discussionmentioning

confidence: 99%

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Aggressive End-of-Life Care and Symptom Relief Treatments in Terminally Ill Patients Who Had Discussed Withdrawal of Mechanical Ventilation: A Hospital-Based Observational Study

Chang

Lin

Chen

et al. 2020

Am J Hosp Palliat Care

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Objective: The aim of this study was to explore the status of aggressive end-of-life care and symptom relief treatments in terminally ill patients who had discussed the withdrawal of mechanical ventilation. Methods: This research is a retrospective observational study based on a chart review. Terminal patients aged ≥20 years, who were intubated with mechanical ventilation support, who underwent hospice-shared care, and who personally, or whose close relatives, had discussed the withdrawal of mechanical ventilation with hospice-shared care team members in a tertiary hospital in Taiwan during 2012 to 2015 were included. Demographics, medical conditions, and aggressive end-of-life care, including hospitalization, use of vasopressors, artificial nutrition, tube feeding, antibiotics, and symptom relief treatments including the use of opioids, steroids, and sedatives, were identified. The modes of care and treatments of patients by the status of withdrawal of mechanical ventilation were compared. Results: A total of 141 patients had discussed the withdrawal of mechanical ventilation, and 111 (78.7%) had been withdrawn. Aggressive end-of-life care was noted in all patients regardless of mechanical ventilation status. There were no significant differences in the number and pattern of aggressive end-of-life care measures between patients who had or had not been withdrawn. There were significantly higher rates of symptom relief treatments used in patients who had been withdrawn. Conclusions: Aggressive end-of-life care is common for patients who have discussed the withdrawal of mechanical ventilation. There are significantly higher rates of symptom relief medications administered in patients who have been withdrawn from mechanical ventilation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Aggressive End-of-Life Care and Symptom Relief Treatments in Terminally Ill Patients Who Had Discussed Withdrawal of Mechanical Ventilation: A Hospital-Based Observational Study

Chang

Lin

Chen

et al. 2020

Am J Hosp Palliat Care

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“…Among 255 American patients who had advanced cancer and had been taking community-based outpatient hospice and palliative care in 2003, a majority of them (79.2%) chose either no antimicrobial therapy (31%) or symptomatic use only (48.2%) [29]. Other studies performed in Taiwan, which has a distinctive culture deeply influenced by Confucianism and Buddhism, have revealed that 45.8% of the patients with terminal cancer expressed their wish to use antimicrobials even in the very terminal stage and 26.4% did not wish to use antimicrobials [7]. The most influential persons were medical professionals [7].…”

Section: Special Considerations For Antimicrobial Stewardship Programmentioning

confidence: 99%

“…Other studies performed in Taiwan, which has a distinctive culture deeply influenced by Confucianism and Buddhism, have revealed that 45.8% of the patients with terminal cancer expressed their wish to use antimicrobials even in the very terminal stage and 26.4% did not wish to use antimicrobials [7]. The most influential persons were medical professionals [7]. A study on 3,840 Korean individuals (1,242 cancer patients, 1,289 family caregivers, and 303 oncologists) showed that a large majority of individuals supported the withdrawal of futile life-sustaining treatment (87.1 – 94.0%) and use of active pain control (89.0 – 98.4%) [30].…”

Section: Special Considerations For Antimicrobial Stewardship Programmentioning

confidence: 99%

“…The colonization of multidrug-resistant organisms (MDROs) was common in patients with advanced-stage illness [45]. Although the risks of antimicrobial therapy should not be overlooked even in terminally ill patients, antimicrobial use may be considered as relatively less aggressive or invasive than other potentially life-sustaining treatments mentioned above [678].…”

Section: Introductionmentioning

confidence: 99%

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Implementation of Antimicrobial Stewardship Programs in End-of-Life Care

Kwon

2019

Infect Chemother

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Many terminal patients at the end-of-life have been receiving antimicrobial therapy despite concerns including futile use, potential lack of efficacy, increased patient burden, excess costs, high risk of adverse effects, and increased antimicrobial resistance. Thus, the implementation of antimicrobial stewardship programs (ASPs) in end-of-life care needs to be discussed. But, the topics of antimicrobial therapy and ASPs have not been addressed in the Life-Sustaining Treatment Decision Act enacted in the Korea in February 2016. Antimicrobial therapy should be included in the decision-making framework for end-of-life care similar to other life-sustaining treatment decisions. If the antimicrobial therapy is legally considered as a life-sustaining treatment which can be withdrawn or withheld in patients at the end-of-life, the feasibility of implementing ASPs among this patient population may improve. Various researches on antimicrobial therapy for patients at the end-of-life need to be conducted and collaborations are required between ASPs professionals and many other concerned parties involved in the legislative process of the Life-Sustaining Treatment Decision Act. This review aims to summarize previous studies on the use of antimicrobials for end-of-life care and reveal important aspects for applying ASPs to this population in Korea.

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Antimicrobial therapy in palliative care: an overview

Macedo

Nunes

Ladeira

et al. 2018

Support Care Cancer

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In the advanced stages of illness, patients often face challenging decisions regarding their treatment and overall medical care. Terminal ill patients are commonly affected by infections. However, in palliative care, the use of antimicrobials can be an ethical dilemma. Deciding whether to treat, withhold, or withdraw the antimicrobial treatment for an infection can be difficult. Antimicrobial administration can lead to adverse outcomes but the two main benefits, longer survival and symptom relief, are the main reasons why physicians prescribe antimicrobial when treating terminally ill patients. For the patient who has an irreversible advanced heart or lung disease, or an advanced dementia, or a metastatic cancer, it is easier the decision of withholding mechanical ventilation, tube feeding, and dialysis than antibiotherapy. To characterize infections, agents, and their treatments in palliative care, we conducted a review of the literature. We also included some tips to help health professionals to guide their clinical approach.

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Wishes of Patients With Terminal Cancer and Influencing Factors Toward the Use of Antibiotics in Taiwan

Cited by 15 publications

References 22 publications

Aggressive End-of-Life Care and Symptom Relief Treatments in Terminally Ill Patients Who Had Discussed Withdrawal of Mechanical Ventilation: A Hospital-Based Observational Study

Aggressive End-of-Life Care and Symptom Relief Treatments in Terminally Ill Patients Who Had Discussed Withdrawal of Mechanical Ventilation: A Hospital-Based Observational Study

Implementation of Antimicrobial Stewardship Programs in End-of-Life Care

Antimicrobial therapy in palliative care: an overview

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