David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
One of the original tenets of the management of neutropenic fever—the prompt initiation of broad spectrum, intravenous antibiotics at the first sign of fever in a neutropenic patient—still holds true today.
Low-risk patients (<7 days of neutropenia) can be treated with oral antibiotics in an ambulatory setting after an initial dose given in the hospital or emergency department.
Given the limitations in the diagnosis of invasive fungal infections, empirical antifungal therapy is still recommended for high-risk patients who remain febrile and neutropenic after 4 to 7 days of antibiotic treatment.
A Web-based decision aid did not improve understanding of the patients' prognosis or affect decision making in this group of surrogate decision makers.
The decision aid did increase surrogate awareness of the clinicians' estimates of 1-year survival, but did not alter the surrogates' own estimates. In addition, surrogates often chose care that was more aggressive than their own self-reported understanding of the patients' wishes. The authors hypothesize that these decisions may be driven by emotion as opposed to reason.
An editorial highlights the remarkable finding of this study—that providing surrogates with additional information does not seem to improve decision making. The editorialists suggest that more research is needed to understand why even informed surrogates cling to overly optimistic prognostic beliefs, and make decisions that seem to be at odds with the patients' wishes.
Wesorick DH, Chopra V. Annals for Hospitalists - 19 March 2019. Ann Intern Med. 2019;170:HO1. doi: https://doi.org/10.7326/AWHO201903190
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Published: Ann Intern Med. 2019;170(6):HO1.
Biliary Disorders, Gastroenterology/Hepatology, Hospital Medicine.
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