Harpaz Itai, Punchik Boris, Freud Tamar, Press Yan
Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Clalit Health Services, Community Division, Ramat-Chen Brull Mental Health Center, Tel Aviv-Yafo, Israel.
Isr J Health Policy Res. 2024 Dec 16;13(1):61. doi: 10.1186/s13584-024-00649-1.
Antibiotic treatment (AT) for patients with advanced dementia and pneumonia is a complex issue. AT can prolong life, but it can also prolong suffering for the patient and the family. In this study we evaluated physicians' attitudes to this issue.
A vignette-based survey among community-based physicians (CBP) and hospital-based physicians (HBP) who work in southern Israel. The physicians were asked to complete a questionnaire on their knowledge and attitudes to AT, based on a case description of a patient with advanced dementia and pneumonia.
211 physicians participated in the study including 134 CBP (63.5%) and 77 HBP (36.5%). 177 physicians chose the AT option for the patient presented in the case, with 59.7% of the HBP and 32.8% of the CBP choosing intravenous (IV) AT (p = 0.017). In contrast, in the same case, but with themselves as the patient, 68.8% of HBP and 32.8% of CBP chose the option of palliative care without AT, with only 14.3% of HBP and 10.4% of CBP choosing the option of hospitalization with IV AT. In two logistic regression models, physicians who chose IV AT for themselves were fourfold more likely to make a similar choice for their patients. Over 75% of the physicians were not knowledgeable about the administration of AT in accordance with the Dying Patient Act.
The results of this study indicate the need for an educational intervention among physicians to expand their knowledge and expertise on end-of-life treatment for patients with advanced dementia. In addition, we invite policy makers to convene a discussion on the possibility of changing the law to facilitate the conduct of studies of patients with advanced dementia. Such studies would make it possible to develop an evidence-based treatment strategy.
晚期痴呆症合并肺炎患者的抗生素治疗（AT）是一个复杂的问题。抗生素治疗可以延长生命，但也可能延长患者及其家属的痛苦。在本研究中，我们评估了医生对这个问题的态度。
对以色列南部工作的社区医生（CBP）和医院医生（HBP）进行基于病例的调查。根据一名晚期痴呆症合并肺炎患者的病例描述，要求医生完成一份关于他们对AT的知识和态度的问卷。
211名医生参与了研究，其中包括134名社区医生（63.5%）和77名医院医生（36.5%）。177名医生为病例中的患者选择了抗生素治疗选项，其中59.7%的医院医生和32.8%的社区医生选择了静脉注射（IV）抗生素治疗（p = 0.017）。相比之下，在同一病例中，但以自己作为患者时，68.8%的医院医生和32.8%的社区医生选择了不进行抗生素治疗的姑息治疗选项，只有14.3%的医院医生和10.4%的社区医生选择了住院并接受静脉注射抗生素治疗。在两个逻辑回归模型中，为自己选择静脉注射抗生素治疗的医生为患者做出类似选择的可能性高出四倍。超过75%的医生不了解根据《临终患者法案》进行抗生素治疗的管理。
本研究结果表明，需要对医生进行教育干预，以扩大他们在晚期痴呆症患者临终治疗方面的知识和专业技能。此外，我们邀请政策制定者就修改法律以促进对晚期痴呆症患者进行研究的可能性展开讨论。这样的研究将有可能制定出基于证据的治疗策略。
