PURPOSE: To determine the perception of futility among frontline intensive care unit (ICU) physicians, nurses and respiratory therapists. Specifically, we sought to (1) generate a working definition of “futility”; (2) determine why ICU caregivers provide “futile” care; (3) identify strategies that might promote a more effective use of ICU resources; and (4) explore whether any changes in policy or legislation might be helpful in reducing the impact of “futile” care in the ICU.
METHODS: We conducted semi-structured interviews of 44 senior physicians, nurses and respiratory therapists from ICUs across Ontario. We then analyzed transcripts of these interviews using grounded theory.
RESULTS: From the interviews, we generated a working definition of futility to mean the use of significant resources without a reasonable hope that the patient would recover to a state of relative independence or be interactive with their environment. Respondents felt that futile care was usually provided because of family demands, a lack of timely or skilled communication, or a lack of consensus among the treating team. Respondents were able to resolve cases of futile care most effectively by improving communication, allowing time for families to experience the ICU environment, or by unilaterally setting limits on supportive care. Respondents felt that further efforts to limit futile care should focus on educating the public and healthcare professionals about the role of the ICU and alternatives such as palliative care, mandating early and skilled discussion of resuscitation status, establishing guidelines for admission to the ICU, and providing a legal framework to support physicians who encounter difficulties applying these guidelines. There was a broad consistency in responses among all disciplines.
CONCLUSION: Ontario's frontline ICU physicians, nurses and respiratory therapists have similar and well-formed opinions about how to define and resolve futile care, and where to focus future efforts to limit the impact of futile care in the ICU.
CLINICAL IMPLICATIONS: The present study identified a working definition of “futile” care, as well as concrete suggestions for reducing the incidence and impact of “futile” care.
DISCLOSURE: James Downar, No Financial Disclosure Information; No Product/Research Disclosure Information