Futile Care in ICU a Common Occurrence, Doctors Say09/10/13
TUESDAY, Sept. 10 (HealthDay News) -- Critical care doctors at a
major teaching hospital believe they provided futile treatment to
about one in five intensive care unit patients, needlessly
prolonging their lives.
ICU doctors in the UCLA Health System said they were certain
they provided futile care for 11 percent of the critically ill
patients they saw over a recent three-month period, and they
strongly suspected that they had provided futile treatment for
another 8.6 percent of patients.
The reported episodes of definite futile care cost the health
system about $2.6 million during the study period, according to an
article published online Sept. 9 in
JAMA Internal Medicine.
"Doctors have fantastic tools at their disposal and frequently rescue people who would otherwise die," said senior author Dr. Neil Wenger, a professor of medicine and director of the UCLA Healthcare Ethics Center in the David Geffen School of Medicine. "These data suggest that some patients are so sick that even with these tools, doctors recognize they can't make them much better."
The study focused on 1,125 patients who received care between
Dec. 15, 2011 and March 15, 2012 at one of the UCLA system's five
The critical care specialists treating these patients filled out
a brief daily questionnaire asking whether they were providing
futile care, defined as intensive care interventions that sustain
life without achieving an outcome that the patient can meaningfully
Patients who received futile care "tended to be the patients who
were sicker and the patients who were older, and particularly
patients who had been transferred in from nursing homes and
long-term care hospitals," Wenger said.
The most common reason doctors perceived an instance of care as
futile was that the burdens to the patients, their families and
their care providers grossly outweighed the benefits. Doctors cited
this as a reason 58 percent of the time.
Other reasons given included:
- Treatment could never reach the patient's goals (51
- Death was imminent (37 percent).
- The patient would never be able to survive outside an ICU (36
Doctors were certain that 123 patients had received futile care,
and time bore out their assessment -- 68 percent of those patients
died during the hospitalization. Survivors were left in severely
compromised health and often dependent on life support.
The average cost for a day of futile treatment in the ICU was
about $4,000, the researchers reported. For the 123 patients
perceived as definitely receiving futile ICU care, total costs
during the three months of the study amounted to $2.6 million.
"If this is happening in hospitals across the country, then consumers of health care are not always getting the treatments that are best targeted to their prognosis, and sometimes resources are used inappropriately," Wenger said.
At least one expert disagrees with the study conclusions,
The findings are limited because they are based solely on
physician perceptions at one academic institution, said Dr. Howard
Epstein, chief health systems officer at the Institute for Clinical
Systems Improvement in St. Paul, Minn.
"The term 'futile' is one I really abhor," Epstein said. "Instead of 'futile,' I use 'non-beneficial care' or 'low-yield treatment.' Because futility, like beauty, is in the eye of the beholder. It's totally dependent on your perspective. If you're a loved one at the bedside with someone near and dear to you, your perspective on futility may be different."
The questionnaire did not go deeper into why "futile" care
occurs, and the researchers will next work to identify those
factors and consider how they might be minimized.
Wenger offered some possible explanations. "Very often, there
hasn't been good enough communication about the fact that a patient
won't survive," he said. "Families may be pushing for continued
aggressive care, hoping against hope."
A doctor's drive to save lives at any cost also might play a
"That's what intensive care units are for, to rescue people," Wenger said. "What's startling is the doctors here told us they were no longer using intensive care in a useful way for the patients."
A more thorough discussion of the costs and benefits of
continued treatment could help doctors and families better judge
whether the care would be helpful or futile, but Wenger said the
parties involved are often reluctant to have that type of talk when
a loved one lies dying.
"It means having a lot of hard conversations. It means talking about what the course of care should be if the surgery doesn't work or if the patient doesn't get better," he said.
"It's much easier to focus on the positive only," he added. "If those conversations don't happen, it's the family left to decide what to do, never having had the opportunity to talk with the patient about it."
For more information on critical care, visit the
U.S. National Institutes of Health.
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