Disease Control and Prevention Center, National Centre for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
J Pain Symptom Manage. 2020 Dec;60(6):1109-1116.e2. doi: 10.1016/j.jpainsymman.2020.06.041. Epub 2020 Jul 4.
Antimicrobials are frequently prescribed to terminally ill patients with cancer; however, physicians' practice patterns regarding antimicrobial use vary widely. This study aimed to systematically identify factors that determine physicians' attitudes toward the management of infectious diseases in terminally ill patients with cancer.
A nationwide cross-sectional survey involving 600 oncologists, 600 infectious diseases physicians, 600 palliative care physicians, and 220 home care physicians was conducted between November 2017 and January 2018. The primary endpoint was physicians' attitudes toward the management of infectious diseases in terminally ill patients with cancer with a few weeks of prognosis. Physicians' beliefs regarding management of infectious diseases as well as physician-perceived "good death" were also assessed (1 = strongly disagree to 6 = strongly agree).
There were 895 (44.3%) analyzable response, and average scores of physicians' attitudes ranged between 2.69 and 4.32. In total, 241 (27%; 95% CI = 24-30) to 691 (78%; 95% CI = 75-81) respondents showed proactive attitudes toward various infectious diseases management. In linear regression analysis, determinants of proactive attitudes included the following: physicians' belief that examination and treatment will improve quality of life and prognosis and reduce suffering (β = 0.32, t = 9.99, P = 0.00); greater physician-perceived importance on receiving enough treatment (β = 0.09, t = 2.88, P = 0.00) and less importance on dying a natural death (β = -0.07, t = -2.14, P = 0.03) for a "good death"; working at a tertiary care hospital (β = 0.16, t = 4.40, P = 0.00); and not being a home care physician (β = -0.20, t = -5.51, P = 0.00) or palliative care physician (β = -0.12, t = -3.64, P = 0.00).
Physicians have divergent attitudes toward the management of infectious diseases in terminally ill patients with cancer. Reflection by physicians on their own beliefs and perceptions regarding infectious disease management and a "good death" may help provide the best end-of-life care.
抗菌药物经常被开给患有癌症的终末期患者；然而，医生对抗生素使用的治疗方案存在很大差异。本研究旨在系统地确定决定医生对终末期癌症患者感染性疾病管理态度的因素。
2017 年 11 月至 2018 年 1 月期间，对 600 名肿瘤学家、600 名传染病医生、600 名姑息治疗医生和 220 名家庭护理医生进行了一项全国性的横断面调查。主要终点是医生对预后数周的终末期癌症患者感染性疾病管理的态度。还评估了医生对感染性疾病管理的信念以及医生感知的“善终”（1=强烈不同意至 6=强烈同意）。
共收到 895 份（44.3%）可分析的回复，医生态度的平均评分为 2.69 至 4.32。共有 241 名（27%；95%CI=24-30）至 691 名（78%；95%CI=75-81）受访者对各种感染性疾病管理表现出积极的态度。在线性回归分析中，积极态度的决定因素包括：医生认为检查和治疗将提高生活质量和预后并减轻痛苦的信念（β=0.32，t=9.99，P=0.00）；医生更重视接受足够的治疗（β=0.09，t=2.88，P=0.00）和不太重视自然死亡（β=-0.07，t=-2.14，P=0.03）的重要性，以实现“善终”；在三级保健医院工作（β=0.16，t=4.40，P=0.00）；而不是家庭护理医生（β=-0.20，t=-5.51，P=0.00）或姑息治疗医生（β=-0.12，t=-3.64，P=0.00）。
医生对终末期癌症患者感染性疾病的管理态度存在分歧。医生对感染性疾病管理和“善终”的信念和认知进行反思，可能有助于提供最佳的临终关怀。
