Futility: clinical decisions at the end-of-life in women with ovarian cancer.
OBJECTIVE
The purpose of this article is to provide a review of the clinical meaning of futility, discuss current normative uses of futility assessments and propose guidelines for clinicians to use in dialogue regarding treatment decisions for patients with advanced ovarian cancers.


METHODS
We performed a MEDLINE literature search of relevant clinical articles for this review that discussed futility and the application to women with ovarian cancer.


RESULTS
Medical futility refers to treatments that serve no physiologic, quantitative or qualitative meaningful purpose. Despite the growth in options focused on symptom management rather than disease eradication, including hospice programs and the more recent development of palliative care programs, there is evidence that many patients continue to receive aggressive interventions, including chemotherapy, until days before their death. While the legal and moral acceptability of treatment limitation is well established, clarity in establishing goals of care, timing of the transition from cure to palliation and communication of specific decisions to withhold further aggressive interventions remain problematic for both patients and clinicians.


CONCLUSIONS
There continues to be a distinct need for both better understanding of the dynamics of patient choice and increased education of physicians in addressing end-of-life care planning. It is essential that we continue to test specific communication and supportive interventions that will improve our ability to help patients avoid the burden of futile therapy while maintaining hope.
von Gruenigen
Vivian E
VE
Department of Reproductive Biology, Division of Gynecologic Oncology, University MacDonald Women's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA. vivian.vongruenigen@uhhs.com
Daly
Barbara J
BJ
D005260:Female; D006801:Humans; D018447:Medical Futility / Q000941:ethics; D010051:Ovarian Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000941:ethics; D017410:Practice Guidelines as Topic; D019452:Terminally Ill