Determinants of physicians' attitudes toward the management of infectious diseases in terminally-ill patients with cancer.

Summary Background Antimicrobials are frequently prescribed to terminally-ill patients with cancer; however, physicians’ practice patterns regarding antimicrobial use vary widely. This study aimed to systematically identify factors that determine physicians’ attitudes toward the management of infectious diseases in terminally-ill patients with cancer. Methods A nationwide cross-sectional survey involving 600 oncologists, 600 infectious diseases physicians, 600 palliative care physicians, and 220 home care physicians was conducted between November 2017 and January 2018. The primary endpoint was physicians’ attitudes toward the management of infectious diseases in terminally-ill patients with cancer with a few weeks of prognosis. Physicians’ beliefs regarding management of infectious diseases as well as physician-perceived ‘good death’ were also assessed (1=strongly disagree–6=strongly agree). Results There were 895 (44.3%) analyzable response, and average scores of physicians’ attitudes ranged between 2.69 and 4.32 In total, 241 (27%; 95%CI=24-30) to 691 (78%; 95%CI=75-81) respondents showed proactive attitudes toward various infectious diseases management. In linear regression analysis, determinants of proactive attitudes included: physicians’ belief that examination and treatment will improve quality of life and prognosis and reduce suffering (β=0.32, t=9.99, p=0.00); greater physician-perceived importance on receiving enough treatment (β=0.09, t=2.88, p=0.00) and less importance on dying a natural death (β=-0.07, t=-2.14, p=0.03) for a ‘good death’; working at a tertiary care hospital (β=0.16, t=4.40, p=0.00); and not being a home care physician (β=-0.20, t=-5.51, p=0.00) or palliative care physician (β=-0.12, t=-3.64, p=0.00). Conclusions Physicians have divergent attitudes toward the management of infectious diseases in terminally-ill patients with cancer. Reflection by physicians on their own beliefs and perceptions regarding infectious disease management and a ‘good death’ may help provide the best end-of-life care.