CHICAGO — Critical care is resource-intensive and limited and the burdens of futile treatment extend beyond the patients who receive it, researchers report.
"Futile treatment is recognized and is common in the ICU," said Thanh Huynh, MD, from the University of California at Los Angeles. "It negatively affects not only the patient who receives futile treatment, but also patients whose care is delayed or unavailable because futile treatment is being provided. Because futile treatment is not beneficial, we need to develop mechanisms that will reorient care to better serve our patients."
Dr. Huynh presented the results here at CHEST 2013.
Her team gathered a focus group of physicians who developed a definition of futile treatment. The physicians agreed that treatment is futile when death is imminent, when the patient is permanently unconscious, when the patient will never survive outside intensive care, and when treatment cannot achieve goals.
Dr. Huynh and her team sought to identify the days when the ICU was full and there was at least 1 person receiving futile treatment. They found that a full unit was less likely to contain a patient receiving futile treatment than one with available beds (38% vs 68%; P < .0001).
"As physicians, consciously or unconsciously, we do try to reduce futile care when the ICU is full," Dr. Huynh explained.
They also identified 9 patients who spent 16 days waiting to be transferred when the ICU was full.
Table. Outcomes of Patients Who Received Futile Treatment (n = 123)
|Died during hospitalization||84|
|Died after hospital discharge and within 6 months of ICU stay||20|
|Discharged home with hospice care||2|
|Discharged to long-term acute hospital||10|
|Discharged to skilled nursing facility||4|
|Transferred to another hospital||1|
|Discharged home to die||1|
"This was a very well-conducted study," said session comoderator Rubin Cohen, MD, from the Feinstein Institute for Medical Research in New Hyde Park, New York.
The presentation generated a great deal of discussion from the audience. One physician called it a "very nice talk," but questioned the use of the term futile, which he perceived to be physician-centered.
"Futility gets us into trouble. Physician-centric is an artful way of saying it," said another audience member. Instead, he suggested that the treatment be called inappropriate.
Dr. Huynh said she understands that the term can lead to discomfort, and explained that the next study will look at whether or not there was a family meeting before the treatment was labeled futile. She also acknowledged that there might be a need to change the name from futile care to something more agreeable to physicians.
She left the outcomes table on the screen for the entire discussion to reinforce the results of futile care.
Dr. Cohen, however, said he is still uncomfortable with the term futile. He explained that the case might not actually be futile. Instead, perhaps, the patient will have a quality of life that is very, very poor.
Dr. Huynh and Dr. Cohen have disclosed no relevant financial relationships.
CHEST 2013: American College of Chest Physicians Annual Meeting. Presented October 28, 2013.
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Cite this: Futile Treatment in Intensive Care Burdens Other Patients - Medscape - Nov 20, 2013.