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Futility and appropriateness: challenging words, important concepts
D Robin Taylor1,2, Calvin J Lightbody3
1Department of Respiratory Medicine, University Hospital Wishaw, Wishaw, UK.
Postgraduate Medical Journal
|February 26, 2018
Summary
Healthcare faces challenges from complex patient needs and limited resources, leading to non-beneficial treatments. Shifting focus from curative intent to appropriateness ensures treatments align with patient goals and values, improving quality of life.
Area of Science:
- Healthcare Management
- Medical Ethics
- Health Services Research
Background:
- Healthcare systems face a 'perfect storm' of increasing comorbidities, high patient expectations, and resource limitations.
- The dominance of the 'curative medical model' contributes to the provision of non-beneficial (futile) treatments.
- Futility in treatment is costly, negatively impacts quality of life (especially end-of-life care), and causes moral distress among healthcare professionals.
Purpose of the Study:
- To analyze the drivers of non-beneficial treatments in healthcare.
- To propose a shift from a purely curative medical model to one emphasizing 'appropriateness' in treatment.
- To advocate for equal valuation of curative and palliative interventions.
Main Methods:
- Conceptual analysis of current healthcare challenges and treatment paradigms.
- Examination of factors contributing to non-beneficial treatments, including personal biases, patient pressures, and institutional factors.
- Proposal of a strategic shift in treatment goals and service design.
Main Results:
- Non-beneficial treatments are driven by a complex interplay of individual, patient, and systemic factors.
- A transition towards 'appropriateness' requires valuing curative and palliative care equally.
- Treatment goals should be determined by illness trajectory, risk-benefit analysis, and patient preferences.
Conclusions:
- Healthcare must move beyond the limitations of the curative model to embrace 'appropriateness'.
- Equalizing the value of curative and palliative interventions is crucial for optimizing patient care.
- Integrating this strategy into professional training and acute service design is essential for effective healthcare delivery.
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