Journal Article

Reasons doctors provide futile treatment at the end of life: a qualitative study

Callaway, Leonie Kaye, Shepherd, Nicole, White, Benjamin, Parker, Malcolm, Graves, Nicholas, Winch, Sarah, Close, Eliana, Willmott, Lindy, Gallois, Cindy

2016

Overview

ObjectiveFutile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patient's life.DesignSemistructured in-depth interviews.SettingThree large tertiary public hospitals in Brisbane, Australia.Participants96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling.ResultsDoctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the main reasons for futile care.ConclusionsDoctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level.

• Publisher: Institute of Medical Ethics and BMJ Publishing Group Ltd,BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Attitude of Health Personnel / Australia / Cardiology / Clinical ethics / Communication / Communication skills / Community life / Death / Death & dying / Decision Making / Discomfort / End of life decisions / Ethics, Clinical / Evaluation / Families & family life / Family roles / Futile medical care / Geriatrics / Health care industry / Hospitals / Humans / Influence / Intensive care / Intensive care units / Internal medicine / Medical decision making / Medical ethics / Medical Futility - ethics / Medical specialists / Medical treatment / Medicine / Older people / Oncology / Palliative care / Palliative Care - ethics / Patients / Physicians / Physicians - psychology / Practice / Practitioner patient relationship / Professional-Patient Relations / Qualitative Research / Reforms / Sampling / Surgery / Terminal care / Terminal Care - ethics / Terminally Ill - psychology / Uncertainty