The meaning of futility through conversation.

Decisions about futility were described as a joint conversation that includes patients, caregivers, and the community at large. Guidelines developed by consortiums such as GUIDe were viewed as contributing positively to the conversation by involving the public voice--a public voice that should be included in conversations at the bedside. Concern that guidelines may insidiously become institutional policies or viewed as blanket rules for decisions was expressed. Several participants cautioned that GUIDe will have a positive influence as long as guidelines and/or standards of practice remain as only a part of the conversation and do not become the conversation. Further, limitations of statistics in individual cases must be recognized. Data from outcomes research was considered as only a component of the conversation because the primary focus of conversation should be on real people in real situations, not extrapolated data. As stated by one of the participants, the most important focus of GUIDe or other similar consortia, may be "on how you hold conversations with people." An interest was expressed in facilitating conversations that enhance both patients' and healthcare providers' particularity, freedom, and awareness and expression of their values and best interests. Such conversations demonstrate respect for each other's positions rather than a wish that the other's world view would just go away.