Improving shared decision-making around antimicrobial-prescribing during the end-of-life period: a qualitative study of Veterans, their support caregivers and their providers

Cassie Cunningham Goedken; Erin Balkenende; Daniel Livorsi; Karleen Giannitrapani; Matthew McCaa; Gosia Clore; Michihiko Goto; Alexandre R Marra; Eli Perencevich

doi:10.1017/ash.2024.61

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Improving shared decision-making around antimicrobial-prescribing during the end-of-life period: a qualitative study of Veterans, their support caregivers and their providers

Journal article

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Peer reviewed

Improving shared decision-making around antimicrobial-prescribing during the end-of-life period: a qualitative study of Veterans, their support caregivers and their providers

Cassie Cunningham Goedken, Erin Balkenende, Daniel Livorsi, Karleen Giannitrapani, Matthew McCaa, Gosia Clore, Michihiko Goto, Alexandre R Marra and Eli Perencevich

Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.4(1), e89

05/01/2024

DOI: 10.1017/ash.2024.61

PMCID: PMC11106728

PMID: 38774117

Appears in UI Libraries Support Open Access

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Abstract

Objective:Antimicrobials are frequently used for palliation during end-of-life care, but adverse effects, such as antimicrobial resistance, are a concern. Shared decision-making is beneficial in end-of-life care conversations to help align antimicrobial-prescribing with patient preferences. However, there is limited data regarding optimal incorporation of antimicrobial-prescribing discussions into shared decision-making conversations. We explored healthcare provider, patient, and support caregiver (eg, family member/friend) perceptions of barriers and facilitators to discussing antimicrobial-prescribing during the end-of-life period.Design:Qualitative study.Participants:Healthcare providers; palliative care/hospice care patients/caregivers.Methods:We conducted semi-structured interviews on shared attitudes/beliefs about antimicrobial-prescribing during end-of-life patient care at one acute-care and one long-term-care facility. Interviews were analyzed for thematic content.Results:Fifteen providers and 13 patients/caregivers completed interviews. Providers recognized the potential benefit of leveraging shared decision-making to guide antimicrobial-prescribing decisions. Barriers included limited face-to-face time with the patient and uncertainty of end-of-life prognosis. Patients/caregivers cited trust, comprehension, and feeling heard as important characteristics which act as facilitators in fostering effective shared decision-making around antimicrobial use. Communication in which providers ensure patients are involved in shared decision-making discussions could be increased to ensure patients and their providers develop a mutually agreeable care plan.Conclusions:Shared decision-making is a practice that can guide antimicrobial-prescribing decisions during end-of-life care, thus potentially minimizing antimicrobial-related adverse effects. Our findings highlight opportunities for increased shared decision-making around antimicrobial use during end-of-life care. Interventions designed to address the identified barriers to shared decision-making have the potential to improve antimicrobial-prescribing practices at end-of-life.

Antibiotics

Antimicrobial Agents

Caregivers

Drug Resistance

Health Care

Hospice Care

Palliative Care

Veterans

Antimicrobial resistance

Data collection

Decision making

Health care policy

Infections

Interviews

Patients

Qualitative research

R&D

Research & development

Side effects

UIOWA OA Agreement

Details

Title: Subtitle: Improving shared decision-making around antimicrobial-prescribing during the end-of-life period: a qualitative study of Veterans, their support caregivers and their providers
Creators: Cassie Cunningham Goedken - University of Iowa
Erin Balkenende - University of Iowa
Daniel Livorsi - University of Iowa
Karleen Giannitrapani - Stanford University School of Medicine
Matthew McCaa - VA Palo Alto Health Care System
Gosia Clore - University of Iowa
Michihiko Goto - University of Iowa
Alexandre R Marra - University of Iowa
Eli Perencevich - University of Iowa
Resource Type: Journal article
Publication Details: Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.4(1), e89
DOI: 10.1017/ash.2024.61
PMID: 38774117
PMCID: PMC11106728
NLM abbreviation: Antimicrob Steward Healthc Epidemiol
eISSN: 2732-494X
Publisher: Cambridge University Press; CAMBRIDGE
Grant note: Research to Impact for Veterans (RIVR): 19-477
The views presented in this manuscript are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government. We thank the VA healthcare providers, patients, and support caregivers who participated in our interviews for their time and willingness to share their experiences. Financial support for this work was supported by Research to Impact for Veterans (RIVR) grant #19-477.
Language: English
Date published: 05/01/2024
Academic Unit: Infectious Diseases; Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984626030802771

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