Antibiotics for URI when on Hospice

Thanks for pointing out the possible side effects of abx treatment. The alteration of the normal gut flora is a serious issue in all pts receiving abx and should be discussed when making a decision regarding abx tx.

Hospice does not mean stop all treatment. It means no CPR or ICU. Its goal is peaceful, natural death. For someone to live a full life, develop cancer/Alzheimers or whatever but then to die of a chest infection (fever/secretions/shortness of breath and the sepsis that goes with it) that could have been treated is a disservice to the patient and their families.

However, we always talk things through with familes and patients - let them know what the full picture is, and come up with a plan that everyone agrees with. Some familes want no antibiotics. Some familes want everything the physician can throw at the patient right up until the end. We even had a family of a terminal patient say that perhaps their relative would have lived a little longer if they had been on an IVI - even after many, many conversations over the pros and cons of fluids in end stage disease.

It's never the same twice. Dont forget that in Hospice care, we're kind of treating the family too. What we dont want is a patient's death and the family start saying 'our relative died too soon because you didn't treat XXXX like we asked.' (It does happen...)

If we routinely stop treating bad chests in hospice because they are going to die soon anyway, then why bother with analgesia and any other meds?

Just my view...

I am the widow of a patient who died almost a year ago while in hospice at home. When my husband got his first URI we left it up to him as to whether or not he got antibiotics - even though he did have a DNR. He chose to fight the infection and I was with him 100% as were the hospice professionals. When he got the second infection he was more ready for the end to come and decided not to treat the infection which spread to his entire body and finally killed him. It was not a pretty thing to watch and I wish I could remove those pictures from my mind. But in the end I believe it was his decision to make even though I would have wanted him to stay here with me.
Given where you work and the type of patient with whom you work, your situation is very different and much more complicated. If a patient did not develop a living will or health care directives before he/she became mentally incapacitated, my guess is you would have to turn to the family and the physician for guidance. I feel that the quality of one's life is an important guidepost. But I do not have any hard and fast rule to go by. My husband and I had discussed in great detail how he wanted to live and how he wanted to die so for us it was not an issue. I applaud your professional decision to work in the area you do. Bless you!

I am in agreement with most here. The philosophy of hospice revolves around quality of life through good symptom management. Therein lies an answer to your question...if they have symptoms from an infection which is adversely affecting quality of life it is very appropriate to treat the infection. In my hospice experience, some patients/families want this and some do not. In my hospice experience, ANY infection with problematic symptoms would potentially be treated regardless of relationship to hospice diagnosis. So, for instance, URI in lung cancer patient is not off limits for treatment...UTI with renal malignancy is not off limits for treatment, etc. There certainly could be conflicts regarding how a particular treatment might be paid for but that discussion does not supercede the provision for good hospice care and good symptom management. Yes, an antibiotic for pneumonia may prolong the patient's life, but more importantly, it will likely improve their quality of life until they die from either their hospice diagnosis, a co-morbidity, or some other complication or event.