Futile care in ICU a common occurrence - NewsChannel5.com | Nashville News, Weather & Sports

Futile care in ICU a common occurrence

Updated:
© iStockphoto.com / Jeffrey Smith © iStockphoto.com / Jeffrey Smith
By Dennis Thompson
HealthDay Reporter

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 ICUs.

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 appreciate.

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 percent).
  • Death was imminent (37 percent).
  • The patient would never be able to survive outside an ICU (36 percent).

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, however.

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 role.

"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."

More information

For more information on critical care, visit the U.S. National Institutes of Health.

Copyright © 2013 HealthDay. All rights reserved.

  • Medical News HeadlinesMedical News HeadlinesMore>>

  • Could Down Syndrome Be The Key To Alzheimer's?

    Could Down Syndrome Be The Key To Alzheimer's?

    Monday, July 21 2014 5:15 PM EDT2014-07-21 21:15:13 GMT
    More than five million Americans are living with Alzheimer’s. More than 400,000 of them also have Down syndrome. What does a condition seen at birth have in common with a disease typically diagnosed in the elderly? Quite a bit.more>>
    More than five million Americans are living with Alzheimer’s. More than 400,000 of them also have Down syndrome. What does a condition seen at birth have in common with a disease typically diagnosed in the elderly? Quite a bit.more>>
  • Extreme Workouts

    Extreme Workouts

    Friday, July 18 2014 6:04 PM EDT2014-07-18 22:04:23 GMT
    Workout routines have taken a tortuous turn. Running through mud and fighting in cages are just some of the latest extreme workouts, but one wrong move and you could be in trouble.more>>
    Workout routines have taken a tortuous turn. Running through mud and fighting in cages are just some of the latest extreme workouts, but one wrong move and you could be in trouble.more>>
  • Extreme Skin

    Extreme Skin

    Thursday, July 17 2014 5:15 PM EDT2014-07-17 21:15:05 GMT
    Last year, Americans underwent more than 11-million cosmetic procedures and spent nearly $12-billion on skin rejuvenation. Everyone wants their skin to look younger, healthier and better, but some are taking it to an extreme.more>>
    Last year, Americans underwent more than 11-million cosmetic procedures and spent nearly $12-billion on skin rejuvenation. Everyone wants their skin to look younger, healthier and better, but some are taking it to an extreme.more>>
  • Extreme Diets

    Extreme Diets

    Wednesday, July 16 2014 5:15 PM EDT2014-07-16 21:15:07 GMT
    Dieting is an American pastime. About 45-million of us diet each year, and we spend about $33-billion on weight-loss products. There are more ways to diet than ever and some are pretty extreme.more>>
    Dieting is an American pastime. About 45-million of us diet each year, and we spend about $33-billion on weight-loss products. There are more ways to diet than ever and some are pretty extreme.more>>
  • Frozen Lumpectomy For Prostate

    Frozen Lumpectomy For Prostate

    Tuesday, July 15 2014 5:15 PM EDT2014-07-15 21:15:08 GMT
    More than 230,000 men will be diagnosed with prostate cancer this year according to the American Cancer Society. In most cases, surgical removal of the gland is considered the gold standard of treatment, but results of a new study suggest a new treatment might benefit some patients.more>>
    More than 230,000 men will be diagnosed with prostate cancer this year according to the American Cancer Society. In most cases, surgical removal of the gland is considered the gold standard of treatment, but results of a new study suggest a new treatment might benefit some patients.more>>
  • Bariatric Surgery For Diabetes

    Bariatric Surgery For Diabetes

    Wednesday, July 9 2014 5:15 PM EDT2014-07-09 21:15:09 GMT
    Nearly 90 percent of people with type-two diabetes are obese and as more Americans gain weight, more will likely face a diabetes diagnosis. In fact, the American Diabetes Association predicts that one in three adults will have diabetes by the year 2050. For years, we’ve heard about weight loss surgery and its effect on diabetes. Now, a new study is showing how well the popular surgery is working to stop this serious disease.more>>
    Nearly 90 percent of people with type-two diabetes are obese and as more Americans gain weight, more will likely face a diabetes diagnosis. In fact, the American Diabetes Association predicts that one in three adults will have diabetes by the year 2050. For years, we’ve heard about weight loss surgery and its effect on diabetes. Now, a new study is showing how well the popular surgery is working to stop this serious disease.more>>
  • Ankle Replacement

    Ankle Replacement

    Tuesday, July 8 2014 5:15 PM EDT2014-07-08 21:15:10 GMT
    More than 50 million Americans suffer from some form of arthritis. Between 6 percent and 13 percent of them have ankle arthritis. These patients feel pain with every single step they take, but now ankle replacements are giving patients a new lease on life.more>>
    More than 50 million Americans suffer from some form of arthritis. Between 6 percent and 13 percent of them have ankle arthritis. These patients feel pain with every single step they take, but now ankle replacements are giving patients a new lease on life.more>>
  • 3D Knee

    3D Knee

    Monday, July 7 2014 5:15 PM EDT2014-07-07 21:15:09 GMT
    In the past ten years, the number of total knee replacements in the U.S. has doubled and many of those patients are much younger than ever before. Now, new technology allows doctors to make replacement knees that are the perfect fit.more>>
    In the past ten years, the number of total knee replacements in the U.S. has doubled and many of those patients are much younger than ever before. Now, new technology allows doctors to make replacement knees that are the perfect fit.more>>
  • Breath of Life for Heart Patients

    Breath of Life for Heart Patients

    Thursday, July 3 2014 6:20 PM EDT2014-07-03 22:20:13 GMT
    Heart failure, 5.7 million people in the U.S. have it and 55-thousand die from it each year. By definition, it means your heart cannot pump enough blood and oxygen to support all your other organs. Now, a simple breath test could make it easier and faster for doctors to diagnose.more>>
    Heart failure, 5.7 million people in the U.S. have it and 55-thousand die from it each year. By definition, it means your heart cannot pump enough blood and oxygen to support all your other organs. Now, a simple breath test could make it easier and faster for doctors to diagnose.more>>
  • Concave Chest In Teens

    Concave Chest In Teens

    Wednesday, July 2 2014 5:15 PM EDT2014-07-02 21:15:06 GMT
    Can you imagine being a teenage boy, living at the beach, and not having enough confidence to take your shirt off and not having enough energy to even take a walk? The condition is called concave chest. One-in-500 kids will be born with it.more>>
    Can you imagine being a teenage boy, living at the beach, and not having enough confidence to take your shirt off and not having enough energy to even take a walk? The condition is called concave chest. One-in-500 kids will be born with it.more>>
*DISCLAIMER*: The information contained in or provided through this site section is intended for general consumer understanding and education only and is not intended to be and is not a substitute for professional advice. Use of this site section and any information contained on or provided through this site section is at your own risk and any information contained on or provided through this site section is provided on an "as is" basis without any representations or warranties.
Powered by WorldNow
Powered by WorldNow
All content © Copyright 2000 - 2014 NewsChannel 5 (WTVF-TV) and WorldNow. All Rights Reserved.
For more information on this site, please read our Privacy Policy and Terms of Service.