Can physicians’ judgments of futility be accepted by patients?: A comparative survey of Japanese physicians and laypeople

Abstract

Back groundEmpirical surveys about medical futility are scarce relative to its theoretical assumptions. We aimed to evaluate the difference of attitudes between laypeople and physicians towards the issue.MethodsA questionnaire survey was designed. Japanese laypeople (via Internet) and physicians with various specialties (via paper-and-pencil questionnaire) were asked about whether they would provide potentially futile treatments for end-of-life patients in vignettes, important factors for judging a certain treatment futile, and threshold of quantitative futility which reflects the numerical probability that an act will produce the desired physiological effect. Also, the physicians were asked about their practical frequency and important reasons for futile treatments.Results1134 laypeople and 401 (80%) physicians responded. In all vignettes, the laypeople were more affirmative in providing treatments in question significantly. As the factors for judging futility, medical information and quality of life (QOL) of the patient were rather stressed by the physicians. Treatment wish of the family of the patient and psychological impact on patient side due to the treatment were rather stressed by laypeople. There were wide variations in the threshold of judging quantitative futility in both groups. 88.3% of the physicians had practical experience of providing futile treatment. Important reasons for it were communication problem with patient side and lack of systems regarding futility or foregoing such treatment.ConclusionLaypeople are more supportive of providing potentially futile treatments than physicians. The difference is explained by the importance of medical information, the patient family’s influence to decision-making and QOL of the patient. The threshold of qualitative futility is suggested to be arbitrary.

Reasons doctors provide futile treatment at the end of life: a qualitative study

“…Doctors from a range of specialties nominated doctor-related, patient-related and hospital-related factors that contributed to futile treatment. This research confirms the reasons for futile treatment identified in other studies, such as patient or family request for treatment,6–11 13–16 19 24 25 clinician practices (including poor communication skills6 7 9 11 15 19 21 24–26 and failure to diagnose end of life),11 21 24 fears of legal consequences,6 8–10 13 15 16 19 20 and institutional fragmentation and specialisation 9–11 13–15 19 21 24. It also reveals deeper insights into these causes.…”

“…To achieve this, we must first understand the complex reasons why such treatment is provided. The literature points to a range of drivers of futile treatment at the end of life, emphasising family and patient request,6–11 13–16 19 24 25 poor communication with patients and families,6 7 9 11 15 19 21 24–26 lack of knowledge about patient wishes,12 13 15 24 conflict with colleagues10 11 13–15 24 25 and legal concerns 6 8–10 13 15 16 19 20. Some also suggest that doctors are responsible for futile treatment (although to a lesser degree than patients or families)7 11 15 19 21 24 27 and a few point to institutional reasons such as time pressure 16 24…”

Nurses' Perceptions of Futile Care

“…The reason is that personal, religious, and cultural beliefs and values as well as socioeconomic factors can contribute to futility. 4,13,14,16,44,49,50 In most cases, health care professionals consider implementing lifesaving interventions for terminally ill patients as futile while patients' families believe that such interventions are effective at least in helping them effectively cope with losing a family member. 7, 46 Whitmer et al 16 also noted that medical futility is a subjective concept that is defined and perceived differently by different people.…”

“…Generally, futility is a complex concept 4,7 because no consensus exists over its definition 4,14,17,18,49 and different factors affect people's perceptions of it. 4,8,9,16,44 …”

“…In other words, a certain type of care that may be considered futile for one patient may be especially needed and effective for another one. Previous studies have shown that factors such as contradiction between physicians' objective findings and patients and families' beliefs; differences in patients, families, and health care professionals' values and preferences 4,16,17,44 ; the likelihood of committing errors in diagnosing patients' underlying problems and identifying their prognoses 8,45 ; cultural and religious beliefs such as expecting a miracle to happen 9,15,45,46 ; emotional issues 4,7,41,46 ; and patients and their families' social, financial, and political positions 41 can affect individuals' perceptions of futility. In line with the findings of the previous studies, 11,46-48 our findings also showed that medical futility is directly related to the aims of treatment plans.…”