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

Area of Science:

• Medical Ethics
• Palliative Care
• Clinical Decision-Making

Background:

• End-of-life care involves complex decisions regarding treatment.
• The terms "futility" and "futile treatment" are frequently used but lack consistent definition.

Purpose of the Study:

• To explore how physicians conceptualize and apply the terms "futility" and "futile treatment" in end-of-life care settings.

Main Methods:

• Qualitative study utilizing semi-structured interviews.
• 96 doctors from diverse specialties treating end-of-life patients were interviewed.
• Interviews were conducted in three major Brisbane teaching hospitals.

Main Results:

• Physicians' understanding of futility centers on the quality and prospect of patient benefit, encompassing physiological effects, life quality, and quantity.
• Assessing the likelihood of patient benefit was often described as subjective.
• Variability exists in applying the concept of futility in clinical decision-making, with some treatments deemed futile yet justifiable.

Conclusions:

• A qualitative approach to assessing futility is preferred, acknowledging inherent variability in clinical decision-making.
• Patient benefit, determined through discussions of values, goals, and treatment burdens/benefits with patients and families, is central to defining futility.
• Understanding physicians' perspectives is crucial for refining end-of-life care communication and decision-making.