Some intensive-care patients receive expensive treatments that don’t prolong life while increasing pain and suffering, a study found.
About 11 percent of critical-care patients at the University of California, Los Angeles, health-care system received what researchers termed futile treatment, the majority dying within six months while still in the hospital, according to a study released today in JAMA Internal Medicine. The cost of treatment was $2.6 million over three months, researchers said.
Today’s findings are the first to look at how pervasive futile medical treatments are for critical-care patients and the costs of those treatments, said Neil Wenger, a senior study author. The findings don’t mean that doctors should withhold treatment and end patients’ lives, just that patients and families should have end-of-life discussions in advance of care to help guide treatment, he said.
“It ought to be a wakeup call for people who use medical care, for people who would like us to use medical care better and to better target the treatments we have available,” Wenger, a professor of medicine at UCLA and director of the UCLA Health Ethics Center, said today in a telephone interview. “This requires a willingness to talk about death and confronting prognosis and these are really hard things to do. Doctors can tell when they’re providing futile treatment and yet the forces that are out there, either inertia or difficult conversations or families wanting to not stop, prevent them from reorienting toward palliation.”
He said not treating these patients won’t reduce hospitals’ health bills because those patients would just be replaced by other potentially sicker patients.
The researchers used a survey to ask critical-care doctors at five intensive-care units for three months to assess if their patients were receiving futile treatment or probably futile treatment. The authors analyzed about 6,900 assessments on 1,125 patients.
They found that 123 patients, or 11 percent, received futile treatment, 98 patients, or 8.6 percent, received probably futile treatment and 904 patients, or 80 percent, received necessary treatment.
Treatments were considered futile if the burden of care outweighed its benefits, the patient’s goals couldn’t be achieved, which varied by patient, death was imminent, the patient couldn’t survive outside of the intensive-care unit and the patient was permanently unconscious.
Decisions over unnecessary medical care are the top reason for ethics consultations in hospitals today, Robert Truog wrote in an editorial accompanying the study. Many hospitals have policies in place that use a hospital ethics committee to make decisions rather than the treating doctors when families or patients ask for care that’s considered futile.
“This isn’t about saying no to families,” Truog, a professor of medical ethics at Harvard Medical School in Boston, said today in a telephone interview. “This is about really helping patients and families have a better idea of what they really want.”
More studies are needed to find better ways for doctors and nurses to talk about end of life in a way that gets families and patients to listen, he said.
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