An evolutionary concept analysis of futility in health care

Morata, Lauren

doi:10.1111/jan.13526

Cited by 21 publications

(20 citation statements)

References 95 publications

(123 reference statements)

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“…The literature shows the emergence of futile care as a concept resulting from the use of medical technology that could sustain a child’s life, but which did not improve the child’s underlying condition. It also refers to technology that could support a child’s life temporarily but ultimately not change the inevitable outcome of death (Brunkhorst et al, 2014; Duff, 1979; Jordan et al, 2018; Morata, 2018; Rivers, 1996; Sundean and McGrath, 2013).…”

Section: Resultsmentioning

confidence: 99%

Approaches to the initiation of life-sustaining technology in children: A scoping review of changes over time

Alexander

Eustace‐Cook

Brenner

2020

J Child Health Care

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Little is understood about the dynamic circumstances within which the initiation of technology dependence takes place in children. The aim of this scoping review was to identify the influences on the initiation of technology dependence and the issues that require further exploration and consideration. Scientific literature that directly or indirectly discussed the initiation of technology dependence in children was identified. A three-stage screening process of title and abstract scrutiny, full-text scanning and in-depth full-text reading resulted in 63 relevant articles from 1133 initially reviewed. These were then subjected to descriptive and thematic analysis. Articles ranged from the 1970s to the present, reflecting the evolution of ethical debates around the approaches to clinical practice and changes in cultural and societal attitudes. Three themes emerged: how technology alters the meaning of futile care, dissonance in the perspectives of decision makers and increasing support for joint decision-making. Only articles in English and predominantly from the clinician’s rather than the patient’s perspective were included. Societal and cultural factors as well as the structural, financial and cultural environment influence the initiation of technology dependence in children. However, to what extent these overt and implicit influences guide decision-makers in this field remains largely unknown.

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Section: Resultsmentioning

confidence: 99%

Approaches to the initiation of life-sustaining technology in children: A scoping review of changes over time

Alexander

Eustace‐Cook

Brenner

2020

J Child Health Care

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“…The clinical evaluation criteria for screening patients in situations of scarcity of resources aim to identify the patients most likely to survive hospital discharge [ 35 ]. The prognosis is one of the parameters used to support decision making in the allocation of intensive care in order to balance benefits and harm, in addition to determining when treatment becomes futile [ 36 ]. However, the prognostic assessment carried out by different members of the same multidisciplinary team may reach different conclusions [ 37 , 38 ].…”

Section: Methodsmentioning

confidence: 99%

COVID-19: instruments for the allocation of mechanical ventilators—a narrative review

et al. 2020

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After the World Health Organization declared COVID-19 to be a pandemic, the elaboration of comprehensive and preventive public policies became important in order to stop the spread of the disease. However, insufficient or ineffective measures may have placed health professionals and services in the position of having to allocate mechanical ventilators. This study aimed to identify instruments, analyze their structures, and present the main criteria used in the screening protocols, in order to help the development of guidelines and policies for the allocation of mechanical ventilators in the COVID-19 pandemic. The instruments have a low level of scientific evidence, and, in general, are structured by various clinical, non-clinical, and tiebreaker criteria that contain ethical aspects. Few instruments included public participation in their construction or validation. We believe that the elaboration of these guidelines cannot be restricted to specialists as this question involves ethical considerations which make the participation of the population necessary. Finally, we propose seventeen elements that can support the construction of screening protocols in the COVID-19 pandemic.

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“…Clinical decision 11 ; Clinical need 8 11 13 21 28 45 ; Clinical judgement 12 47 ; End-of-life care 48 ; Following guidelines 49 ; Guidelines 17 ; Intensive treatment 48 ; Judgement of futility 14 ; Prognosis 16 21 24 42 ; Prognostication 22 ; Requirement to make a decision 14 ; Treatment 8 27 29 34 ; Treatment decision 26 Quality of life 50 ; Unconsciousness of patient 43 ; Well-being 28 Communication 15 24 42 51 ; Corporate policy 49 ; Decision-making 30 ; Disputes and obstacles to good care 44 ; Duty 12 52 ; Ethics 12 29 Fear 43 ; Interpretation of policy 49 ; Information provision 26 39 ; Legal influence 47 ; Medical principle 24 ; Moral dilemmas 21 ; Obligation to relieve suffering 19 ; Obligation 53 ; Purpose of role 19 ; Responsibility 23 24 28 35 47 52 ; Widespread belief 52 Being familiar with patient or ward 13 ; Compassion 19 ; Cultural influences 49 ; Distress 44 ; Emotions 35 ; Experience maturity 15 35 ; Professional experience 13 ; Professional objectivity 35 ; Religion 13 ; Values 16 52…”

Section: Rejecting Technology Initiationmentioning

confidence: 99%

Initiating technology dependence to sustain a child’s life: a systematic review of reasons

et al. 2021

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BackgroundDecision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a result helps determine the range of influences on these decisions.MethodsMedline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence.Results53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care.ConclusionsThere is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside ‘end-of-life’ care. This review provides a sound basis for empirical research into the important influences on a child’s potential technology dependence.

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An evolutionary concept analysis of futility in health care

Cited by 21 publications

References 95 publications

Approaches to the initiation of life-sustaining technology in children: A scoping review of changes over time

Approaches to the initiation of life-sustaining technology in children: A scoping review of changes over time

COVID-19: instruments for the allocation of mechanical ventilators—a narrative review

Initiating technology dependence to sustain a child’s life: a systematic review of reasons

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