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

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

doi:10.1016/j.resinv.2020.05.003

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

Respir Investig. 2020 Nov;58(6):488-494. doi: 10.1016/j.resinv.2020.05.003. Epub 2020 Jul 3.

Authors

Takahiro Takazono¹, Yoshifumi Imamura², Kaoru Kawakami³, Naoya Yamasaki⁴, Hiroyoshi Shimizu⁴, Katsuhiro Usuki⁵, Maiko Kiyohara², Tatsuro Hirayama², Masato Tashiro⁶, Naoki Hosogaya², Tomomi Saijo², Kazuko Yamamoto², Taiga Miyazaki⁷, Katsunori Yanagihara⁸, Koichi Izumikawa⁶, Hiroshi Mukae²

Affiliations

¹ Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan. Electronic address: takahiro-takazono@nagasaki-u.ac.jp.
² Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.
³ Health Care Corporation Syowakai, Syowakai Hospital, Nagasaki, Japan.
⁴ Health Care Corporation Keiseikai, Shimizu Hospital, Nagasaki, Japan.
⁵ Health Care Corporation Hakuwakai, Atago Hospital, Nagasaki, Japan.
⁶ Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
⁷ Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.
⁸ Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

PMID: 32631765
DOI: 10.1016/j.resinv.2020.05.003

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.

Keywords: Advance care planning; Advance directive; Antibiotics; Elderly patients; Terminal-phase pneumonia.

Publication types

Multicenter Study

MeSH terms

Aged
Humans
Japan / epidemiology
Physicians*
Pneumonia* / epidemiology
Pneumonia* / therapy
Surveys and Questionnaires
Terminal Care*