111: StAR: Use of antimicrobials at the end of life

Managing infections at the end of life requires integrating a palliative care lens to address moral distress and improve clinical decision-making. When source control for infections like recurrent abscesses or pneumonia becomes unfeasible, clinicians should shift from curative goals to prioritizing patient-centered values. The REMAP framework—reframing the situation, expecting emotion, mapping values, aligning with those values, and proposing a plan—serves as a vital tool for navigating these complex conversations. Time-limited trials for antibiotics offer a structured approach to balance the desire to exhaust interventions with the need to avoid prolonged, non-beneficial treatments. Ultimately, clinicians must recognize that requests for aggressive antibiotic therapy often stem from emotional needs, such as guilt or a sense of obligation, rather than purely clinical indications, necessitating collaborative efforts between infectious disease and palliative care teams to ensure compassionate, goal-concordant care.