Therapeutic obstinacy and futile treatments in end-of- life care - the perceptions of health-care professionals

Abstract

The treatment of terminally ill patients raises many dilemmas that make it difficult to draw a line between treatment of uncertain benefits and therapeutic utility. Aim: To synthesize the qualitative and quantitative evidence on the views, experiences and perceptions of doctors and nurses from different specialties involved in the care of people nearing the end of life in relation to therapeutic obstinacy and futility. Design: Systematic review and narrative synthesis of qualitative and quantitative studies. Data sources: PubMed, PsycINFO, the International Association for Hospice and Palliative Care/Cumulative Index of Nursing and Allied Health Literature [IAHPC/CINAHL], and Communication & Mass Media Complete [CMMC] databases. Review methods: Databases were searched for studies from May 2016 to November 2021. Pediatric studies, family/relative viewpoints, advance care directives, and euthanasia studies were excluded. Results were synthesized using a narrative synthesis approach with thematic analysis. Results: 8 studies were included. Conclusion: Despite different perceptions among health professionals, the complexity of supporting therapy obstinacy and futile therapies lead to burnout, professional dissatisfaction and impaired communication skills among health professionals. Impact: This review will be of interest to palliative care, oncology and critical care practitioners and those planning to train and practice in these fields and will also provide inputs to debates on ethical issues in end-of-life care.