Futile Care in ICU a Common Occurrence, Doctors Say
Costly treatments are not always in line with patient's prognosis, researcher contends
Doctors were certain that 123 patients had received futile care, and time bore out their assessment -- 68 percent of those patients died during the hospitalization. Survivors were left in severely compromised health and often dependent on life support.
The average cost for a day of futile treatment in the ICU was about $4,000, the researchers reported. For the 123 patients perceived as definitely receiving futile ICU care, total costs during the three months of the study amounted to $2.6 million.
"If this is happening in hospitals across the country, then consumers of health care are not always getting the treatments that are best targeted to their prognosis, and sometimes resources are used inappropriately," Wenger said.
At least one expert disagrees with the study conclusions, however.
The findings are limited because they are based solely on physician perceptions at one academic institution, said Dr. Howard Epstein, chief health systems officer at the Institute for Clinical Systems Improvement in St. Paul, Minn.
"The term 'futile' is one I really abhor," Epstein said. "Instead of 'futile,' I use 'non-beneficial care' or 'low-yield treatment.' Because futility, like beauty, is in the eye of the beholder. It's totally dependent on your perspective. If you're a loved one at the bedside with someone near and dear to you, your perspective on futility may be different."
The questionnaire did not go deeper into why "futile" care occurs, and the researchers will next work to identify those factors and consider how they might be minimized.
Wenger offered some possible explanations. "Very often, there hasn't been good enough communication about the fact that a patient won't survive," he said. "Families may be pushing for continued aggressive care, hoping against hope."
A doctor's drive to save lives at any cost also might play a role.
"That's what intensive care units are for, to rescue people," Wenger said. "What's startling is the doctors here told us they were no longer using intensive care in a useful way for the patients."
A more thorough discussion of the costs and benefits of continued treatment could help doctors and families better judge whether the care would be helpful or futile, but Wenger said the parties involved are often reluctant to have that type of talk when a loved one lies dying.