Critical care physicians often perceive life-prolonging interventions as costly and ultimately futile, according to a new report in the Journal of the American Medical Association (JAMA).
Researchers describe these intensive care interventions as "futile care" that prolonged a patient's life without any beneficial effect for the patient. Such care, the report states, "is contrary to professional values, inappropriately uses health care resources, and creates moral distress."
The study calls on participating physicians to monitor patients receiving treatment they believed to be futile in five intensive care units for a three-month period.
Over the course of the study, 36 critical care specialists made 6,916 assessments of 1,136 patients. Of the patients assessed:
- the specialists perceived 8.6 percent as "probably" receiving futile treatment.
- 11 percent of patients were perceived as receiving futile treatment.
- patients in the latter group received a total of 464 days of treatment perceived as futile.
- 84 of the 123 patients receiving futile treatment died prior to discharge.
- 20 more died within half a year of discharge.
The health systems were estimated to have spent $2.6 million on futile treatment in critical care.
"Advances in medicine enable critical care specialists to save lives as well as prolong dying. An admission to the intensive care unit (ICU) should be considered a therapeutic trial," the report states. "[A]ggressive critical care should transition to palliative care once it is clear that the treatment will not achieve an acceptable health state for the patient."
According to the report, a survey of Canadian ICU physicians found nearly 90 percent believed patients in their ICU had been provided with futile treatment in the past year.
A JAMA study last year similarly found the perception of inappropriate care (defined as care differing from personal and professional beliefs) was widespread in European and Israeli ICUs; 25 percent of nurses, 32 percent of ICU physicians and 27 percent of clinicians across the board identified inappropriate care in at least one patient. This perception was found to contribute to distress and clinician turnover, FierceHealthcare previously reported.
To learn more:
- here's the JAMA abstract