Abstract
Infections frequently trigger or worsen disabling symptoms at the end-of-life. Clinical judgement prevails to determine antimicrobial usage, in the absence of best practice guidelines. Particularly for lung cancer, neoplasms can facilitate or mimic respiratory infections. We aimed to describe antimicrobial prescription habits at the end of life for lung cancer patients and identify the factors conditioning clinical decisions. We surveyed medical specialities frequently involved in end-of-life decisions for lung cancer patients by an online questionnaire. IBM SPSS was used to perform statistical analysis. We collected 110 answers from medical doctors, mainly Pulmonologists (n=59, 53,6%) and women (n=81, 73,6%). A proportion of 17,3% received post-graduate education in palliative care, although only 2,7% worked at palliative care centres. The most frequent reasons to suspect infection and initiate antimicrobials were fever (n=99, 90,00%), the onset of purulent sputum (n=100, 90,90%), radiologic changes (n=81, 73,60%) and high acute-phase parameters (n=82, 74,55%). Post-graduate formation in palliative care was associated with lower tendency to perform invasive procedures (sample collection, p=0,037 and IV antimicrobials, p<0,001), as well as a more prompt decision to suspend antimicrobials when futility was apparent (p=0,004). Most clinicians found antimicrobial discontinuation protocols useful in this setting (n=95, 86,36%). This work shows clinicians acknowledge a beneficial role for antimicrobial discontinuation protocols and that palliative care education influences antimicrobial prescription practices for lung cancer patients and the end of life.
Footnotes
Cite this article as: European Respiratory Journal 2021; 58: Suppl. 65, PA3856.
This abstract was presented at the 2021 ERS International Congress, in session “Prediction of exacerbations in patients with COPD”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2021