Futile Care in ICU a Common Occurrence, Doctors Say
Costly treatments are not always in line with patient's prognosis, researcher contends
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.
"It means having a lot of hard conversations. It means talking about what the course of care should be if the surgery doesn't work or if the patient doesn't get better," he said.
"It's much easier to focus on the positive only," he added. "If those conversations don't happen, it's the family left to decide what to do, never having had the opportunity to talk with the patient about it."