Discrepancies in preferences regarding the care of terminal-phase pneumonia in elderly patients among patients, families, and doctors: A multicenter questionnaire survey in nagasaki, Japan.

Abstract

BACKGROUND:

Before advance care planning, it is essential to understand the differences in preferences for medical care of terminal-phase pneumonia in elderly patients among the patients, their families, and their doctors. This study aimed to clarify these differences and investigate the actual care provided to elderly patients with pneumonia in nursing hospitals.

METHODS:

Multicenter questionnaire surveys of 179 patients admitted to nursing homes and long-term care beds in hospitals of three healthcare corporations, their families, and their physicians were conducted between January and August 2018. The questionnaires mainly assessed preferences for life-prolonging medical care procedures, including antibiotic treatments, in terminal-phase pneumonia. A follow-up survey regarding the prognosis and the actual care provided by the physicians was conducted 1 year after the first survey.

RESULTS:

Only 16.2% of the patients had sufficient prior discussions with their families about their care. More families preferred cardiac massage, intubation, and tracheostomy, while fewer families preferred peripheral intravenous fluids or antibiotics than physicians. A total of 30 patients' families (16.7%) answered to withhold antibiotic treatment, while all physicians supported antibiotic administration. The only significant factor related to withholding antibiotics was high age (P = 0.0057). The follow-up survey administered to the doctors revealed that 49 patients (35.7%) had died within one year. Of the 137 patients, 54 patients (39.4%) had developed pneumonia during this observation period and all were treated with antibiotics.

CONCLUSIONS:

This study revealed large discrepancies between patients/families and physicians regarding preferences for care. Medical staff should make efforts to fill the gap by ensuring advance care planning.

• Authors: Takahiro Takazono, Yoshifumi Imamura, Kaoru Kawakami, Naoya Yamasaki, Hiroyoshi Shimizu, Katsuhiro Usuki, Maiko Kiyohara, Tatsuro Hirayama, Masato Tashiro, Naoki Hosogaya, Tomomi Saijo, Kazuko Yamamoto, Taiga Miyazaki, Katsunori Yanagihara, Koichi Izumikawa, Hiroshi Mukae
• Journal: Respiratory investigation (Respir Investig) Vol. 58 Issue 6 Pg. 488-494 (Nov 2020) ISSN: 2212-5353 [Electronic] Netherlands
• PMID: 32631765 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2020 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Topics

• Aged
• Humans
• Japan (epidemiology)
• Physicians
• Pneumonia (epidemiology, therapy)
• Surveys and Questionnaires
• Terminal Care