111: StAR: Use of antimicrobials at the end of life
Sep 23, 2024
auto_awesome
Join Daniel Karlin, an antimicrobial expert from UCLA, Christine Pham, a seasoned professional in antimicrobial applications, and Daisuke Furukawa, a Stanford researcher specializing in antibacterial studies, as they navigate the complexities of antimicrobial use at the end of life. They delve into ethical dilemmas, emphasizing the need for clear communication and palliative care integration. The trio also reflects on emotional challenges faced by healthcare providers and families, advocating for better collaboration and understanding in managing infections during terminal care.
Antimicrobial stewardship at the end of life necessitates early discussions about treatment limitations to enhance patient-provider communication and trust.
Integrating palliative care principles into infectious disease management helps redefine treatment goals towards comfort rather than aggressive interventions.
Deep dives
The Role of Antimicrobial Stewardship
Antimicrobial stewardship is crucial in managing infections, especially in patients with poor prognoses. It emphasizes the need for healthcare providers to understand the limitations and potential harm caused by antibiotics in the face of incurable diseases. Discussions around the appropriateness of antibiotic treatment should begin early, ideally before the patient reaches multiple hospital admissions, to foster better communication and trust between care teams and patients. By addressing the complexity of infections in the context of an underlying disease, healthcare teams can guide patients through the treatment process more effectively.
Integrating Palliative Care with Infectious Disease Management
Integrating palliative care principles into infectious disease management can significantly enhance patient care. This approach includes openly discussing the incurability of infections and redefining treatment goals, focusing on comfort rather than aggressive antibacterial protocols. Communication among healthcare providers is critical in ensuring a unified message is conveyed to the patient regarding the potential outcomes of continued treatment. The REMAP framework—Reframe, Expect Emotion, Map Out Patient Goals, Align with Those Goals, and Propose a Plan—serves as a guideline for these discussions and helps in formulating patient-centered care plans.
Navigating Complex Emotions in Patient Care
Healthcare providers often encounter complex emotions from patients and families in end-of-life scenarios, which can heavily influence treatment decisions. Feelings of guilt or obligation can lead families to insist on continuing treatments that may not provide clinical benefits, such as antibiotics for infections. Addressing these emotions directly is essential, providing support while explaining the implications of these treatment choices. The involvement of palliative care professionals can offer valuable insight and strategies for managing these emotional challenges effectively.
Assessing the Value of Antibiotics in Advanced Illness
The clinical benefits of antibiotics in end-of-life care can vary significantly depending on the type of infection and patient condition. In cases such as UTIs, symptom relief can be quite effective with antibiotics, whereas for pneumonia or sepsis, the impact may be minimal or even detrimental. It's crucial for healthcare teams to evaluate whether the antibiotics align with the patient's comfort and quality of life goals. Engaging in conversations about the appropriateness of treatments, including the potential for ongoing resistance and side effects, can lead to more informed and compassionate decision-making.