Homepage > Research abstracts > Antibiotic use for terminal ill hospitalized patients at the end of life: The present status and investigation of sociodemographic, motivational factors and hospital physicians’ burnout related to physician intentions and behavior
Antibiotic use for terminal ill hospitalized patients at the end of life: The present status and investigation of sociodemographic, motivational factors and hospital physicians’ burnout related to physician intentions and behavior
Researchers: Talma Kushnir1, Yaacov Bachner1, Abraham Borer2, Rina Fedorowsky3
- Ben-Gurion University if the Negev
- Soroka Medical Center
- Hashron Hospital, Rabin Medical Center
Background: Over-use of antibiotics (AB) at the end of life (EOL) in patients with advance directives, increases bacterial resistance and causes morbidity and mortality. In order to reduce the threat, physicians should apply The Terminally ill Patients Law, which enables them to withhold AB at the EOL.
Objectives: To examine AB use, and to investigate motivational factors and their association with physician intentions and actual use of AB at the EOL.
Method: A descriptive-correlational research in which 213 physicians were sampled, in acute and post-acute care and their patients (932) in the last two weeks of their lives.
Findings: Of the 932 deaths, more than half were EOL patients with Advance Directive (435/664).
Of these, 74% received AB, and in only 4%, AB was discontinued and 32% were infected with AB resistance bacteria. AB use was significantly higher in post-acute care than in acute care. Only half of the physicians were familiar with the Israeli law guidelines concerning avoiding AB at the EOL, and less than half knew the correct prevalence of bacterial resistance.
The predictive/related variables to their intentions to discontinue AB/AB use in EOL patients with advance directive are: seniority, managerial position, board certification, type of hospitalization, positive attitudes, barriers and depersonalization. In addition, there was a significant positive association between physician intention to discontinue AB and AB use after advance directive decisions of patients at the EOL.
Of these, 74% received AB, and in only 4%, AB was discontinued and 32% were infected with AB resistance bacteria. AB use was significantly higher in post-acute care than in acute care. Only half of the physicians were familiar with the Israeli law guidelines concerning avoiding AB at the EOL, and less than half knew the correct prevalence of bacterial resistance.
The predictive/related variables to their intentions to discontinue AB/AB use in EOL patients with advance directive are: seniority, managerial position, board certification, type of hospitalization, positive attitudes, barriers and depersonalization. In addition, there was a significant positive association between physician intention to discontinue AB and AB use after advance directive decisions of patients at the EOL.
Conclusions and Recommendations: There is an over-use of AB at the EOL. Improving knowledge, increasing infectious disease physician involvement and dissemination of guidelines, are expected to reduce AB use and bacterial resistance, thereby increasing public health protection.
Research number: A/129/2015
Research end date: 11/2018