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

Willmot, Lindy, White, Benjamin, Gallois, Cindy, Parker, Malcolm, Graves, Nicholas, Winch, Sarah, Callaway, Leonie Kaye, Shepherd, Nicole and Close, Eliana (2016) Reasons doctors provide futile treatment at the end of life: a qualitative study. Journal of Medical Ethics, 42 8: 496-503. doi:10.1136/medethics-2016-103370


Author Willmot, Lindy
White, Benjamin
Gallois, Cindy
Parker, Malcolm
Graves, Nicholas
Winch, Sarah
Callaway, Leonie Kaye
Shepherd, Nicole
Close, Eliana
Title Reasons doctors provide futile treatment at the end of life: a qualitative study
Journal name Journal of Medical Ethics   Check publisher's open access policy
ISSN 1473-4257
0306-6800
Publication date 2016
Year available 2016
Sub-type Article (original research)
DOI 10.1136/medethics-2016-103370
Open Access Status Not Open Access
Volume 42
Issue 8
Start page 496
End page 503
Total pages 8
Place of publication London, United Kingdom
Publisher BMJ Publishing Group
Collection year 2017
Language eng
Formatted abstract
Objective Futile 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.

Design Semistructured 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. 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.

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.
Keyword End of life care
Care of the dying patient
Decision making
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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Created: Fri, 01 Jul 2016, 15:30:15 EST by Dr Malcolm Parker on behalf of School of Medicine