Objectives Development of evidence-based good practice recommendations for clinicians considering the use of antibiotics in patients towards the end of life.
Design A multiprofessional group of experts in end-of-life care and antimicrobial stewardship was convened. Findings from a scoping review of the literature and a consultation of clinicians were triangulated. Expert discussion was used to generate consensus on how to approach decision-making.
Setting Representatives from hospital and a range of community health and care settings.
Participants Medical, pharmacy and nursing professionals.
Main outcome measures Good practice recommendations based on published evidence and the experience of prescribers in Scotland.
Results The findings of 88 uncontrolled, observational studies of variable quality were considered alongside a survey of over 200 prescribers. No national or international guidelines were identified. Antibiotic use towards the end of life was common but practice was highly variable. The potential harms associated with giving antibiotics tended to be less well considered than the potential benefits. Antibiotics often extended the length of time to death but this was sometimes at the cost of higher symptom burden. There was strong consensus around the importance of effective communication with patients and their families and making treatment decisions aligned to a patient’s goals and priorities.
Conclusions Good practice recommendations were agreed with focus on three areas: making shared decisions about future care; agreeing clear goals and limits of therapy; reviewing all antibiotic prescribing decisions regularly. These will be disseminated widely to support optimal care for patients towards the end of life. A patient version of the recommendations has also been produced to support implementation.
- symptoms and symptom management
- end of life care
- clinical decisions
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Contributors RAS, JS and JF conceived the project. LC and JC designed the studies, collected and analysed data. LC, JS and RAS drafted the manuscript. JF, SP, LF, TD and SG reviewed and commented on manuscript and approved final draft.
Funding LC, JS and RAS contributions to this work were undertaken as part of their roles in the Scottish Antimicrobial Prescribing Group. JF was funded by the Royal College of Physicians and Surgeons of Glasgow for undertaking this work as part of a Scottish Clinical Leadership Fellowship focused on antimicrobial stewardship across several areas of practice including end of life care. All authors contributed to this work as part of their clinical role.
Competing interests None declared.
Patient consent for publication Not required.
Data availability statement No data are available.
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