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

Willmott, Lindy, White, Benjamin P., Gallois, Cindy, Parker, Malcolm, Graves, Nicholas, Winch, Sarah, Callaway, Leonie, Shepherd, Nicole, & Close, Eliana (2016) Reasons doctors provide futile treatment at the end of life: A qualitative study. Journal of Medical Ethics, 42, pp. 496-503.

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Abstract

Objective

  • Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment which they consider to be futile is sometimes provided at the end of a patient’s life.

Design

  • Semi-structured in-depth interviews.

Setting

  • Three large tertiary public hospitals in Brisbane, Australia.

Participants

  • 96 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.

Results

  • Doctors 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. Secondly, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty, and lack of information about patient wishes. Thirdly, 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.

Conclusions

  • Doctors 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.

Impact and interest:

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ID Code: 95734
Item Type: Journal Article
Refereed: Yes
Keywords: Futile treatment, Futility, End of life decision-making, Withholding and withdrawing life-sustaining treatment, Doctors' perceptions
DOI: 10.1136/medethics-2016-103370
ISSN: 0306-6800
Subjects: Australian and New Zealand Standard Research Classification > PHILOSOPHY AND RELIGIOUS STUDIES (220000) > APPLIED ETHICS (220100) > Bioethics (human and animal) (220101)
Australian and New Zealand Standard Research Classification > PHILOSOPHY AND RELIGIOUS STUDIES (220000) > APPLIED ETHICS (220100) > Medical Ethics (220106)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > QUT Faculties and Divisions > Faculty of Law
Current > Research Centres > Australian Centre for Health Law Research
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Law
Funding:
Copyright Owner: Copyright 2016 The Author(s)
Deposited On: 23 May 2016 23:12
Last Modified: 30 Jul 2016 06:22

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