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>>

  • Ocular Melanoma: Saving Lives, Saving Eyes

    Ocular Melanoma: Saving Lives, Saving Eyes

    Friday, April 11 2014 5:15 PM EDT2014-04-11 21:15:07 GMT
    Ocular melanoma, also called uveal melanoma, is a rare type of melanoma that targets the eye. It can be a deadly if it isn't spotted early enough. Now, there's a way to treat patients that's saving lives and saving eyes.more>>
    Ocular melanoma, also called uveal melanoma, is a type of melanoma that targets the eye. It affects about 2,000 people a year in the United States. Although rare – it can be a deadly if it isn't spotted early enough. Now, there's a way to treat patients that's saving lives and saving eyes.more>>
  • Memory Palace: Coping With Chemo Brain

    Memory Palace: Coping With Chemo Brain

    Thursday, April 10 2014 5:15 PM EDT2014-04-10 21:15:09 GMT
    More than 13 million Americans are living with some form of cancer. Harsh treatments like chemo and radiation save lives, but they will also change lives. Now, many cancer survivors are learning how to cope with chemo brain.more>>
    More than 13 million Americans are living with some form of cancer. Harsh treatments like chemo and radiation save lives, but they will also change lives. Now, many cancer survivors are learning how to cope with chemo brain.more>>
  • Pedaling For A Cure

    Pedaling For A Cure

    Wednesday, April 9 2014 5:15 PM EDT2014-04-09 21:15:09 GMT
    Five years ago, Leslie Trudeau's world came crashing down. At just 22 years old, her son Taylor lost his battle with leukemia. That's why Trudeau is pedaling for a cure.more>>
    Five years ago, Leslie Trudeau's world came crashing down. At just 22 years old, her son Taylor lost his battle with leukemia. That's why Trudeau is pedaling for a cure.more>>
  • Bringing Hearts Back To Life: New Improved Defibrillator

    Bringing Hearts Back To Life: New Improved Defibrillator

    Tuesday, April 8 2014 5:15 PM EDT2014-04-08 21:15:13 GMT
    CPR and a portable defibrillator helped keep Eric Robinson alive after he went into cardiac arrest. And now a newly FDA approved Biotronik implantable cardiac defibrillator, or ICD, constantly monitors his heart.more>>
    A year ago, while jamming with his son's band, Eric Robinson went into cardiac arrest. CPR and a portable defibrillator helped keep Robinson alive. And now a newly FDA approved Biotronik implantable cardiac defibrillator, or ICD, constantly monitors his heart.more>>
  • Helping High Risk Hearts

    Helping High Risk Hearts

    Monday, April 7 2014 5:15 PM EDT2014-04-07 21:15:09 GMT
    Ironing is not exactly Barbara Roy's favorite activity, but it's something she's glad she can do again. Her doctor diagnosed her with severe aortic stenosis.more>>
    Ironing is not exactly Barbara Roy's favorite activity, but it's something she's glad she can do again. Her doctor diagnosed her with severe aortic stenosis.more>>
  • Hernias In Newborns: Lincoln's Story

    Hernias In Newborns: Lincoln's Story

    Friday, April 4 2014 5:15 PM EDT2014-04-04 21:15:07 GMT
    Congenital diaphragmatic hernias occur in about one in every 2,000 births. They can be deadly, but now doctors are using a more aggressive treatment approach.more>>
    Congenital diaphragmatic hernias occur in about one in every 2,000 births. They can be deadly, but now doctors are using a more aggressive treatment approach.more>>
  • Predicting Bad Hearts

    Predicting Bad Hearts

    Thursday, April 3 2014 5:15 PM EDT2014-04-03 21:15:09 GMT
    Every year, more than 700,000 Americans have a heart attack. Now, researchers at Baylor Research Institute at Dallas have uncovered a biomarker that may help them spot the disease sooner.more>>
    Every year, more than 700,000 Americans have a heart attack. And 600,000 die of heart disease. Now, researchers at Baylor Research Institute at Dallas have uncovered a biomarker that may help them spot the disease sooner; and they did it by pure accident.more>>
  • Giving Shannon A Voice Of Her Own

    Giving Shannon A Voice Of Her Own

    Wednesday, April 2 2014 5:15 PM EDT2014-04-02 21:15:05 GMT
    More than half a million children under age 15 has a severe communication disorder impairing their ability to speak or communicate with others. Now, advances in technology are giving them a voice—some for the first time.more>>
    More than half a million children under age 15 has a severe communication disorder impairing their ability to speak or communicate with others. Now, advances in technology are giving them a voice—some for the first time.more>>
  • Getting On Your Nerves To Save Your Heart

    Getting On Your Nerves To Save Your Heart

    Tuesday, April 1 2014 5:15 PM EDT2014-04-01 21:15:06 GMT
    Heart failure is the fastest growing cardiovascular disorder in the U.S., affecting more than 6 million people. However, now a new device that gets on your nerves could help save those with heart failure.more>>
    Heart failure is the fastest growing cardiovascular disorder in the U.S., affecting more than 6 million people. It occurs when a person's heart is too weak to pump and circulate blood in the body. However, now a new device that gets on your nerves could help save those with heart failure.more>>
  • New Way To Hear For Grayson: Brain Stem Implant

    New Way To Hear For Grayson: Brain Stem Implant

    Monday, March 31 2014 5:15 PM EDT2014-03-31 21:15:07 GMT
    Imagine being born profoundly deaf: missing the vital nerve needed for you to hear. Without it, you had no options; until now.more>>
    Imagine being born profoundly deaf: missing the vital nerve needed for you to hear. Without it, you had no options; until now.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.