What does “futility” mean? An empirical study of doctors' perceptions

White, Benjamin P.; Willmott, Lindy; Close, Eliana; Shepherd, Nicole; Gallois, Cindy; Winch, Sarah; Graves, Nicholas; Callaway, Leonie K.

doi:10.5694/mja15.01103

Cited by 41 publications

(33 citation statements)

References 26 publications

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“…These two authors (CP, CtH) iteratively discussed themes and checked for the analytical link to transcripts. 21 Then, all four authors scrutinised and discussed the data, explicitly searching for negative case analysis before refining themes. 19 Rigour was further promoted through prolonged engagement by one of the authors (CP) with the tenants over 3 years.…”

Section: Methodsmentioning

confidence: 99%

Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness

Parsell

Have

Denton

et al. 2018

Aust. Health Review

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Objectives The aims of the present study were to examine tenants' experiences of a model of integrated health care and supportive housing and to identify whether integrated health care and supportive housing improved self-reported health and healthcare access. Methods The present study used a mixed-method survey design (n=75) and qualitative interviews (n=20) performed between September 2015 and August 2016. Participants were tenants of permanent supportive housing in Brisbane (Qld, Australia). Qualitative data were analysed thematically. Results Integrated health care and supportive housing were resources for tenants to overcome systematic barriers to accessing mainstream health care experienced when homeless. When homeless, people did not have access to resources required to maintain their health. Homelessness meant not having a voice to influence the health care people received; healthcare practitioners treated symptoms of poverty rather than considering how homelessness makes people sick. Integrated healthcare and supportive housing enabled tenants to receive treatment for health problems that were compounded by the barriers to accessing mainstream healthcare that homelessness represented. Conclusions Extending the evidence about housing as a social determinant of health, the present study shows that integrated health care and supportive housing enabled tenants to take control to self-manage their health care. In addition to homelessness directly contributing to ill health, the present study provides evidence of how the experience of homelessness contributes to exclusions from mainstream healthcare. What is known about the topic? People who are homeless experience poor physical and mental health, have unmet health care needs and use disproportionate rates of emergency health services. What does the paper add? The experience of homelessness creates barriers to accessing adequate health care. The provision of onsite multidisciplinary integrated health care in permanent supportive housing enabled illness self-management and greater control over lifestyle, and was associated with self-reported improved health and life satisfaction in formerly homeless tenants. What are the implications for practitioners? Integrated health care and supportive housing for the formerly homeless can improve self-reported health outcomes, enable healthier lifestyle choices and facilitate pathways into more appropriate and effective health care.

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Section: Methodsmentioning

confidence: 99%

Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness

Parsell

Have

Denton

et al. 2018

Aust. Health Review

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“…) and our limited contact time with any one patient . However, we find that meeting the ‘gold standard’ can be aided by lists that reference the concept of ‘futility’ . There are a number of these, one example is represented in Table .…”

Section: Initiating Planning In the Patient Approaching End‐of‐lifementioning

confidence: 99%

“…15 However, we find that meeting the 'gold standard' can be aided by lists that reference the concept of 'futility'. 16 There are a number of these, one example is represented in Table 2. [17][18][19][20] Recent research has shown that the use of one such list is acceptable and reliable in the ED setting.…”

Section: Initiating Planning In the Patient Approaching End-of-lifementioning

confidence: 99%

Approach to death in the older emergency department patient

Arendts

Carpenter

Hullick

et al. 2016

Emerg Medicine Australasia

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“…This paper addresses this gap. Drawing on a larger project looking at how doctors conceptualise futile treatment,20 and the reasons they provide it,4 it reports on how doctors view the relationship between futility and resources, both conceptually and in their descriptions of their practice.…”

Section: Introductionmentioning

confidence: 99%

Doctors’ perceptions of how resource limitations relate to futility in end-of-life decision making: a qualitative analysis

White

Willmott

et al. 2019

J Med Ethics

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ObjectiveTo increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.SettingThree tertiary hospitals in metropolitan Brisbane, Australia.DesignQualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic analysis.ResultsDoctors’ perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing.ConclusionsDoctors’ ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors’ role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making.

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What does “futility” mean? An empirical study of doctors' perceptions

Cited by 41 publications

References 26 publications

Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness

Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness

Approach to death in the older emergency department patient

Doctors’ perceptions of how resource limitations relate to futility in end-of-life decision making: a qualitative analysis

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