Ben White1, Lindy Willmott2, Eliana Close2, Nicole Shepherd3, Cindy Gallois4, Malcolm H Parker4, Sarah Winch4, Nicholas Graves5, Leonie K Callaway4. 1. Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD bp.white@qut.edu.au. 2. Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD. 3. Queensland University of Technology, Brisbane, QLD. 4. University of Queensland, Brisbane, QLD. 5. Institute of Health and Biomedical Information, Queensland University of Technology, Brisbane, QLD.
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.
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.
Authors: Matthew H Anstey; Edward Litton; Michelle L Trevenen; Kelly Thompson; Steve Webb; Ian Seppelt; Imogen A Mitchell Journal: Intensive Care Med Date: 2019-02-06 Impact factor: 17.440
Authors: Hannah E Carter; Sarah Winch; Adrian G Barnett; Malcolm Parker; Cindy Gallois; Lindy Willmott; Ben P White; Mary Anne Patton; Letitia Burridge; Gayle Salkield; Eliana Close; Leonie Callaway; Nicholas Graves Journal: BMJ Open Date: 2017-10-16 Impact factor: 2.692
Authors: Xing J Lee; Alison Farrington; Hannah Carter; Carla Shield; Nicholas Graves; Steven M McPhail; Gillian Harvey; Ben P White; Lindy Willmott; Magnolia Cardona; Ken Hillman; Leonie Callaway; Adrian G Barnett Journal: BMC Geriatr Date: 2020-07-29 Impact factor: 3.921