According to a recent article from WebMD, critical care doctors believed they provided futile care to 1 in 5 patients in the ICU by needlessly prolonging their lives.
The study was done at the UCLA Healthcare System between December 2011 and March 2012. Critical care doctors noted that they provided futile care for 11 percent of their critically ill patients at a cost to the healthcare system of $2.6 million.
The study focused on 1,125 patients over a three-month period of time. Futile care was defined as intensive care interventions that sustain life without achieving an outcome that the patient can meaningfully appreciate. The patients who received this futile care were usually sicker and older, especially those from nursing homes and long-term care hospitals. The most common reason they felt care in the ICU was futile was that the burdens to the patients, their families, and their care providers grossly outweighed the benefits. Other reasons identified were:
- Death was imminent
- The patient would never survive outside the ICU
- Treatment could not meet the patientís goals
The researchers analyzed 6,897 assessments of the 1,125 patients. The team found that 904 patients (80 percent) did not receive futile treatment, 98 patients (9 percent) more than likely received futile treatment, and 123 patients (11 percent) received futile treatment.
The most common reason treatment was seen as futile was because the burdens of aggressive therapy grossly outweighed its potential benefit. This something many of us have probably witnessed among our oncology patients as well.
It is also important to note that while 11 percent of these patients did receive futile care, 85 percent of them died within the hospital setting, and the survivors were left in a very poor state of health.
These are the results of one study and more research needs to be done, but it does raise some concerns regarding patient outcomes and quality of life.
This article had great significance for me as I often see patients with advanced metastatic cancer being treated in the ICU. Some recover to face another round of chemotherapy and extended survival, but many do not. Recently a patient spent three months in the hospital, with the majority of the time in the ICU. He developed sepsis and multisystem organ failure. He would take one step forward and two steps back throughout his entire hospital stay. He eventually was referred for hospice care and ended up dying one day after admission.
Why does this happen? Possibly because of poor communication regarding expected outcomes. Families may be pushing for continued aggressive care and doctors strive to save lives. Doctors may be unwilling to have a talk about benefits of continued treatment when someoneís loved one is dying.
These are hard conversations. Itís easier to focus on the positive when the nephrologist says the kidney function is better today or the cardiologist says the heart is stable, or when the oncologist says if he gets better we can give him more chemotherapy instead of someone talking about the patient as a whole with all their comorbidities, expected outcomes, and quality of life.
How do we focus on providing the right care at the right time? When is the right time to stop providing futile care? What has been your experience in dealing with this issue?