In one of the first studies of its kind, researchers from UCLA and the RAND Corp. looked at the prevalence and the cost of critical care therapies provided in intensive care units that physicians perceive as being "futile."
Reporting in JAMA Internal Medicine, the researchers found that the majority of patients admitted to the ICU received appropriate care but that 11 percent of them received treatments during their ICU course that their physicians saw as futile. The study took place within the UCLA health system. While previous studies of ICU physicians in the U.S., Canada and Europe have shown that such futile care occurs, the UCLA–RAND team wanted to better quantify the frequency and expense of physician-perceived futile treatment in adult critical care.
"Recognizing and quantifying the prevalence and cost of futile treatment is the first step toward refocusing medical treatments to those that are more likely to benefit patients," the study's first author, Thanh Huynh, M.D., a clinical instructor of medicine in the division of pulmonary and critical care medicine at the David Geffen School of Medicine at UCLA, said in a statement accompanying the study's publication.
The researchers analyzed 6,897 assessments of 1,125 patients. The team found that 904 patients (80 percent) did not receive futile treatment, 98 patients (9 percent) received probably futile treatment, and 123 patients (11 percent) received futile treatment. Of the 123 patients who received futile treatment, 85 percent died within six months, most of them during their hospitalization; the surviving patients were left in severely compromised health states and were often dependent on life-sustaining modalities.
The most common reason treatment was seen as futile was because the burdens of aggressive therapy grossly outweighed its potential benefit. Other reasons included: the treatment could never achieve the patient's goals, death was imminent, the patient would never be able to survive outside of an ICU, and the patient was permanently unconscious. For most patients, there was more than one reason their treatment was considered futile, the researchers said.
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