Reasons Doctors Provide Futile Treatment at the End of Life: A Qualitative Study

Abstract

Objective: Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment which they consider to be futile is sometimes provided at the end of a patient’s life.

Design: Semi‐structured in‐depth interviews.

Setting: Three large tertiary public hospitals in Brisbane, Australia.

Participants: 96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine, and medical administration departments. Participants were recruited using purposive maximum variation sampling.

Results: Doctors attributed the provision of futile treatment to a wide range of inter‐related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk, and poor communication skills. Secondly, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty, and lack of information about patient wishes. Thirdly, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the main reasons for futile care.

Keywords: Futile Treatment, Futility, End of Life Decision-Making, Withholding and Withdrawing Life-Sustaining Treatment, Doctors' Perceptions