The Community Perspective on Potentially Inappropriate Treatment

Area of Science:

• Medical Ethics
• Public Health Policy
• Patient-Centered Care

Background:

• Healthcare providers often deem life-prolonging treatments without patient-appreciated benefit as futile or inappropriate.
• Guidelines exist for resolving clinician-family conflicts, aiming to increase public engagement.
• Limited evaluation exists on laypeople's understanding of medical futility and inappropriate treatment.

Purpose of the Study:

• To assess community perspectives on the definition and implications of futile medical treatment.
• To explore public understanding of terminology surrounding end-of-life care decisions.

Main Methods:

• Conducted six focus groups across different age demographics (under 65, 65-75, over 75).
• Participants (n=39) had prior hospitalization experience.
• Grounded theory analysis of discussions on defining futile treatment and decision-making in conflicts.

Main Results:

• Community members struggled with the concept and terminology of futile treatment, though recognized examples when presented.
• Difficulties stemmed from poor communication, lack of end-of-life focus, skepticism, and fears of undermining autonomy.
• Participants strongly favored families as ultimate decision-makers in conflicts.

Conclusions:

• Significant public education is needed to improve understanding of inappropriate medical treatment at end-of-life.
• Enhanced public discourse and policy development require laypeople to be familiar with medical futility concepts.
• Addressing communication gaps and fears is essential for effective public engagement in end-of-life care policy.