Concordance of Nurses and Physicians on Whether Critical Care Patients are Receiving Futile Treatment.
BACKGROUND
Nurses and physicians often describe critical care that is not expected to provide meaningful benefit to a patient as futile, and providing treatments perceived as futile is associated with moral distress.


OBJECTIVE
To explore concordance of physicians' and nurses' assessments of futile critical care.


METHODS
A focus group of clinicians developed a consensus definition of "futile" critical care. Daily for 3 months, critical care physicians and nurses in a health care system identified patients perceived to be receiving futile treatment. Assessments and patients' survival were compared between nurses and physicians.


RESULTS
Nurses and physicians made 6254 shared assessments on 1086 patients. Nurses and physicians assessed approximately the same number of patients as receiving futile treatment (110 for nurses vs 113 for physicians, P = .82); however, concordance was low as to which patients were assessed as receiving futile treatment (κ = 0.46). The 110 patients categorized by nurses as receiving futile treatment had lower 6-month mortality than did the 113 patients so assessed by physicians (68% vs 85%, P = .005). Patients who were assessed as receiving futile treatment by both providers were more likely to die in the hospital than were patients assessed as receiving futile treatment by the nurse alone (76% vs 32%, P < .001) or by the physician alone (76% vs 57%, P = .04).


CONCLUSIONS
Interprofessional concordance on provision of critical care perceived to be futile is low; however, joint predictions between physicians and nurses were most predictive of patients' outcomes, suggesting value in collaborative decision making.
Thanh H. Neville is an assistant clinical professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA). Joshua F. Wiley is a doctoral student in the Department of Psychology, UCLA and a senior analyst for the Elkhart Group Ltd, Columbia City, Indiana. Myrtle C. Yamamoto is a manager in quality improvement, Department of Medicine, David Geffen School of Medicine, UCLA. Mark Flitcraft is the nursing director of the medical intensive care unit, Department of Nursing, David Geffen School of Medicine, UCLA. Barbara Anderson is nursing director of the neuroscience critical care unit, Department of Nursing, David Geffin School of Medicine, UCLA. J. Randall Curtis is a professor, Division of Pulmonary and Critical Care, University of Washington, Seattle. Neil S. Wenger is a professor, UCLA Health Ethics Center, Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA and a researcher at RAND Health, Santa Monica, California. tneville@mednet.ucla.edu.
Thanh H
TH
Neville
Thanh H. Neville is an assistant clinical professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA). Joshua F. Wiley is a doctoral student in the Department of Psychology, UCLA and a senior analyst for the Elkhart Group Ltd, Columbia City, Indiana. Myrtle C. Yamamoto is a manager in quality improvement, Department of Medicine, David Geffen School of Medicine, UCLA. Mark Flitcraft is the nursing director of the medical intensive care unit, Department of Nursing, David Geffen School of Medicine, UCLA. Barbara Anderson is nursing director of the neuroscience critical care unit, Department of Nursing, David Geffin School of Medicine, UCLA. J. Randall Curtis is a professor, Division of Pulmonary and Critical Care, University of Washington, Seattle. Neil S. Wenger is a professor, UCLA Health Ethics Center, Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA and a researcher at RAND Health, Santa Monica, California.
Joshua F
JF
Wiley
Thanh H. Neville is an assistant clinical professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA). Joshua F. Wiley is a doctoral student in the Department of Psychology, UCLA and a senior analyst for the Elkhart Group Ltd, Columbia City, Indiana. Myrtle C. Yamamoto is a manager in quality improvement, Department of Medicine, David Geffen School of Medicine, UCLA. Mark Flitcraft is the nursing director of the medical intensive care unit, Department of Nursing, David Geffen School of Medicine, UCLA. Barbara Anderson is nursing director of the neuroscience critical care unit, Department of Nursing, David Geffin School of Medicine, UCLA. J. Randall Curtis is a professor, Division of Pulmonary and Critical Care, University of Washington, Seattle. Neil S. Wenger is a professor, UCLA Health Ethics Center, Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA and a researcher at RAND Health, Santa Monica, California.
Myrtle C
MC
Yamamoto
Thanh H. Neville is an assistant clinical professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA). Joshua F. Wiley is a doctoral student in the Department of Psychology, UCLA and a senior analyst for the Elkhart Group Ltd, Columbia City, Indiana. Myrtle C. Yamamoto is a manager in quality improvement, Department of Medicine, David Geffen School of Medicine, UCLA. Mark Flitcraft is the nursing director of the medical intensive care unit, Department of Nursing, David Geffen School of Medicine, UCLA. Barbara Anderson is nursing director of the neuroscience critical care unit, Department of Nursing, David Geffin School of Medicine, UCLA. J. Randall Curtis is a professor, Division of Pulmonary and Critical Care, University of Washington, Seattle. Neil S. Wenger is a professor, UCLA Health Ethics Center, Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA and a researcher at RAND Health, Santa Monica, California.
Mark
M
Flitcraft
Thanh H. Neville is an assistant clinical professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA). Joshua F. Wiley is a doctoral student in the Department of Psychology, UCLA and a senior analyst for the Elkhart Group Ltd, Columbia City, Indiana. Myrtle C. Yamamoto is a manager in quality improvement, Department of Medicine, David Geffen School of Medicine, UCLA. Mark Flitcraft is the nursing director of the medical intensive care unit, Department of Nursing, David Geffen School of Medicine, UCLA. Barbara Anderson is nursing director of the neuroscience critical care unit, Department of Nursing, David Geffin School of Medicine, UCLA. J. Randall Curtis is a professor, Division of Pulmonary and Critical Care, University of Washington, Seattle. Neil S. Wenger is a professor, UCLA Health Ethics Center, Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA and a researcher at RAND Health, Santa Monica, California.
Barbara
B
Anderson
Thanh H. Neville is an assistant clinical professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA). Joshua F. Wiley is a doctoral student in the Department of Psychology, UCLA and a senior analyst for the Elkhart Group Ltd, Columbia City, Indiana. Myrtle C. Yamamoto is a manager in quality improvement, Department of Medicine, David Geffen School of Medicine, UCLA. Mark Flitcraft is the nursing director of the medical intensive care unit, Department of Nursing, David Geffen School of Medicine, UCLA. Barbara Anderson is nursing director of the neuroscience critical care unit, Department of Nursing, David Geffin School of Medicine, UCLA. J. Randall Curtis is a professor, Division of Pulmonary and Critical Care, University of Washington, Seattle. Neil S. Wenger is a professor, UCLA Health Ethics Center, Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA and a researcher at RAND Health, Santa Monica, California.
J Randall
JR
Curtis
Thanh H. Neville is an assistant clinical professor, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA). Joshua F. Wiley is a doctoral student in the Department of Psychology, UCLA and a senior analyst for the Elkhart Group Ltd, Columbia City, Indiana. Myrtle C. Yamamoto is a manager in quality improvement, Department of Medicine, David Geffen School of Medicine, UCLA. Mark Flitcraft is the nursing director of the medical intensive care unit, Department of Nursing, David Geffen School of Medicine, UCLA. Barbara Anderson is nursing director of the neuroscience critical care unit, Department of Nursing, David Geffin School of Medicine, UCLA. J. Randall Curtis is a professor, Division of Pulmonary and Critical Care, University of Washington, Seattle. Neil S. Wenger is a professor, UCLA Health Ethics Center, Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA and a researcher at RAND Health, Santa Monica, California.
Neil S
NS
Wenger
D001291:Attitude of Health Personnel; D003422:Critical Care / Q000523:psychology / Q000706:statistics & numerical data*; D064648:Critical Care Nursing / Q000706:statistics & numerical data*; D017144:Focus Groups; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data*; D009741:Nursing Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data*; D010820:Physicians