Factors associated with futile end-of-life intensive care in a cancer hospital

Abstract

Background: Management of critically ill patients involves weighing potential benefit of advanced life support against preserving quality of life, avoidance of futile measures and rational use of resources.

Aim: Our study aims to identify the predisposing factors involved in the institution and maintenance of futile intensive care support in terminally ill cancer patients in whom no additional treatment for the malignant disease would be offered.

Design: We retrospectively analysed the medical records of patients who died in a tertiary cancer hospital (Hospital A C Camargo, São Paulo, Brazil) during an eight month period. Medical futility was defined when a patient, despite having been stated in the hospital records as having no possible lifespan extending treatment, was admitted to intensive care and received advanced life support. These cases were compared to controls who received palliative end-of-life care.

Results: Three hundred and forty-seven deaths were recorded, of which 238 did not undergo futile treatment, 71 received full code treatment and 38 received futile treatments. Statistically significant predisposing factors for medical futility were, in our analysis, lack of palliative care team consultation (p < 0.001) and hematologic malignancy (p = 0.036). Qualitative analysis of medical records traced futile treatments to physicians' lacking proactive attitudes in considering prognosis and talking to families.

Conclusions: We conclude that a significant minority of end-of-life care consists of futile treatments. Strategies to increase Oncologists' and Critical Care specialists' alertness to these issues and expand indications of Palliative Care consultations are recommended.

Keywords: intensive care; medical futility; neoplasms; palliative care; retrospective studies; withholding treatment.