State-of-the-Art Review: Use of Antimicrobials at the End of Life

Area of Science:

• Medical Ethics
• Infectious Diseases
• Palliative Care

Background:

• Antibiotic use at the end of life presents unique challenges for infectious disease (ID) physicians.
• ID physicians are well-positioned to guide treatment due to continuity of care for complex infections.
• Patient-centered care and shared decision-making are paramount in end-of-life antibiotic management.

Purpose of the Study:

• To explore the role of ID physicians in end-of-life antibiotic decision-making.
• To identify communication strategies that support shared decision-making and patient values.
• To enhance antibiotic stewardship in palliative care settings.

Main Methods:

• Qualitative analysis of physician experiences and perspectives.
• Review of communication strategies in palliative care.
• Framework development for shared decision-making in end-of-life infections.

Main Results:

• ID physicians require specialized communication skills to navigate end-of-life antibiotic choices.
• Aligning antibiotic therapy with patient goals and values is crucial.
• Shared decision-making models can be adapted for antibiotic stewardship.

Conclusions:

• ID physicians play a vital role in end-of-life antibiotic management.
• Enhanced communication skills are essential for effective patient-centered care.
• Integrating stewardship principles into palliative care improves outcomes.