The Medical Futility Experience of Nurses in Caring for Critically Ill Patients

Hsu, Ming‐Yi; Su, Shu‐Fen; Chiang, Lien-Ying; Shih, Sou-Jen; Chen, Yu‐Chen

doi:10.1097/jnr.0000000000000221

Cited by 7 publications

(10 citation statements)

References 18 publications

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“…Those who were more severely unwell, who were emergency admissions and had longer ICU or hospital stays, and who were more elderly, were more likely to receive non-beneficial treatment. Such patients would also be more likely to have impaired ability for decision-making [ 64 , 76 ]. In addition, religious beliefs can underpin pushing for likely clinically non-beneficial outcomes ( n = 3).…”

Section: Resultsmentioning

confidence: 99%

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A systematic review defining non-beneficial and inappropriate end-of-life treatment in patients with non-cancer diagnoses: theoretical development for multi-stakeholder intervention design in acute care settings

Graves

Chee

et al. 2022

BMC Palliat Care

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Background Non-beneficial treatment is closely tied to inappropriate treatment at the end-of-life. Understanding the interplay between how and why these situations arise in acute care settings according to the various stakeholders is pivotal to informing decision-making and best practice at end-of-life. Aim To define and understand determinants of non-beneficial and inappropriate treatments for patients with a non-cancer diagnosis, in acute care settings at the end-of-life. Design Systematic review of peer-reviewed studies focusing on the above and conducted in upper-middle- and high-income countries. A narrative synthesis was undertaken, guided by Realist principles. Data sources Cochrane; PubMed; Scopus; Embase; CINAHL; and Web of Science. Results Sixty-six studies (32 qualitative, 28 quantitative, and 6 mixed-methods) were included after screening 4,754 papers. Non-beneficial treatment was largely defined as when the burden of treatment outweighs any benefit to the patient. Inappropriate treatment at the end-of-life was similar to this, but additionally accounted for patient and family preferences. Contexts in which outcomes related to non-beneficial treatment and/or inappropriate treatment occurred were described as veiled by uncertainty, driven by organizational culture, and limited by profiles and characteristics of involved stakeholders. Mechanisms relating to ‘Motivation to Address Conflict & Seek Agreement’ helped to lessen uncertainty around decision-making. Establishing agreement was reliant on ‘Valuing Clear Communication and Sharing of Information’. Reaching consensus was dependent on ‘Choices around Timing & Documenting of end-of-life Decisions’. Conclusion A framework mapping determinants of non-beneficial and inappropriate end-of-life treatment is developed and proposed to be potentially transferable to diverse contexts. Future studies should test and update the framework as an implementation tool. Trial registration PROSPERO Protocol CRD42021214137.

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Section: Resultsmentioning

confidence: 99%

“…Adding complexity is the consideration of resource consumption and economic burden to the healthcare system [ 66 , 68 , 76 , 89 , 90 ]. This relates to contexts involving staff burnout and moral distress [ 75 , 91 – 94 ] that have been demonstrated to accompany decisions to treat when little or no hope of benefit exists.…”

Section: Discussionmentioning

confidence: 99%

A systematic review defining non-beneficial and inappropriate end-of-life treatment in patients with non-cancer diagnoses: theoretical development for multi-stakeholder intervention design in acute care settings

Graves

Chee

et al. 2022

BMC Palliat Care

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“…The phenomenological study by Hsu et al 22 found that nurses identify four categories of therapeutic futility, and provides nurses' definitions of therapeutic futility and patient types, considerations of therapeutic futility, occurrences of therapeutic futility, and responses to therapeutic futility. Nurses consider that this phenomenon can occur in two situations, namely, when there is no evidence that improvement in health or quality of life can be guaranteed with the implementation of a treatment, or when the interventions implemented to support vital functions facilitate the death process.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of intensive care unit nurses of therapeutic futility: A scoping review

2020

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Introduction Intensive care units are contexts in which, due to the remarkable existence of particularly technological resources, interventions are promoted to extend the life of people who experience highly complex health situations. This ability can lead to a culture of death denial where the possibility of implementing futile care and treatment cannot be excluded. Objective To describe nurses’ perceptions of adult intensive care units regarding the therapeutic futility of interventions implemented to persons in critical health conditions. Method Review of the literature following the Scoping Review protocol of the Joanna Briggs Institute. The Population, Concept, and Context mnemonic was used to elaborate the research question and the research was performed using the EBSCOHost search engine in the CINAHL Complete databases, MEDLINE Complete, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews to identify studies published between 1990 and 2019. Seven studies were selected. Results Nurses consider that therapeutic futility, a current problem in adult intensive care units, may have a negative impact on persons in critical health conditions and that contributes directly to resource expenditure and moral conflicts and consequently leads to emotional exhaustion. Conclusion Due to the complexity of this concept, knowing and understanding people’s and families’ perceptions is crucial to the decision-making process, for which reason nurses can play a key role in managing these situations.

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“…One of the most important aspects of this debate concerns communication, i.e. beyond respect for the autonomy of the dying person, there must be permanent and effective communication between health professionals, the patient and, if possible, the family [44].…”

Section: Education and Empowermentmentioning

confidence: 99%

Ethical and Legal Issues in End-of-life Care: The Case of Life Prolongation

Macedo¹

2022

Research Developments in Arts and Social Studies Vol. 6

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This article aims to make an ethical and legal reflection on end-of-life care, specifically on life-prolongation resulting from technical and diagnostic investment in current health care. This practice called dysthanasia, which in practice is also known as therapeutic obstinacy or futility in care -which is still present in health care -is well described and censored in the deontological codes of doctors and nurses and legal texts (specifically in Portugal). However, despite these documents and the national and international guidelines that contribute to preventing this phenomenon, we conclude that in parallel we need to promote death education -especially end-of-life bioethical issues -, for health professionals in particular, and society in general. The awareness of this issue, through education, will contribute to the empowerment of citizens, more humanization of health care, and, above all, a way to prevent the acts of prolonging the dying process.

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The Medical Futility Experience of Nurses in Caring for Critically Ill Patients

Cited by 7 publications

References 18 publications

A systematic review defining non-beneficial and inappropriate end-of-life treatment in patients with non-cancer diagnoses: theoretical development for multi-stakeholder intervention design in acute care settings

A systematic review defining non-beneficial and inappropriate end-of-life treatment in patients with non-cancer diagnoses: theoretical development for multi-stakeholder intervention design in acute care settings

Perceptions of intensive care unit nurses of therapeutic futility: A scoping review

Ethical and Legal Issues in End-of-life Care: The Case of Life Prolongation

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