What does “futility” mean? An empirical study of doctors’ perceptions

White, Ben, Willmott, Lindy, Close, Eliana, Shepherd, Nicole, Gallois, Cindy, Parker, Malcolm H., Winch, Sarah, Graves, Nicholas and Callaway, Leonie K. (2016) What does “futility” mean? An empirical study of doctors’ perceptions. Medical Journal of Australia, 204 8: 318.e1-318.e5. doi:10.5694/mja15.01103

Author White, Ben
Willmott, Lindy
Close, Eliana
Shepherd, Nicole
Gallois, Cindy
Parker, Malcolm H.
Winch, Sarah
Graves, Nicholas
Callaway, Leonie K.
Title What does “futility” mean? An empirical study of doctors’ perceptions
Journal name Medical Journal of Australia   Check publisher's open access policy
ISSN 1326-5377
Publication date 2016-05-02
Year available 2016
Sub-type Article (original research)
DOI 10.5694/mja15.01103
Open Access Status Not Open Access
Volume 204
Issue 8
Start page 318.e1
End page 318.e5
Total pages 5
Place of publication Strawberry Hills, Australia
Publisher Australasian Medical Publishing
Collection year 2017
Formatted abstract
Objective: To investigate how doctors define and use the terms “futility” and “futile treatment” in end-of-life care.

Design, setting, participants: A qualitative study using semi-structured interviews with 96 doctors from a range of specialties which treat adults at the end of life. Doctors were recruited from three large Brisbane teaching hospitals and were interviewed between May and July 2013.

Results: Doctors’ conceptions of futility focused on the quality and prospect of patient benefit. Aspects of benefit included physiological effect, weighing benefits and burdens, and quantity and quality of life. Quality and length of life were linked, but many doctors discussed instances in which benefit was determined by quality of life alone. Most described assessing the prospects of achieving patient benefit as a subjective exercise. Despite a broad conceptual consensus about what futility means, doctors noted variability in how the concept was applied in clinical decision making. More than half the doctors also identified treatment that is futile but nevertheless justified, such as short term treatment that supports the family of a dying person.

Conclusions: There is an overwhelming preference for a qualitative approach to assessing futility, which inevitably involves variability in clinical decision making. Patient benefit is at the heart of doctors’ definitions of futility. Determining patient benefit requires discussing with patients and their families their values and goals as well as the burdens and benefits of further treatment.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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