title: Reasons doctors provide futile treatment at the end of life: a qualitative study.
abstract: Futile treatment, which by definition cannot benefit a patient, is undesirable. This research investigated why doctors believe that treatment that they consider to be futile is sometimes provided at the end of a patient's life.
  
  
  
  Semistructured in-depth interviews.
  
  
  
  Three large tertiary public hospitals in Brisbane, Australia.
  
  
  
  96 doctors from emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration departments. Participants were recruited using purposive maximum variation sampling.
  
  
  
  Doctors attributed the provision of futile treatment to a wide range of inter-related factors. One was the characteristics of treating doctors, including their orientation towards curative treatment, discomfort or inexperience with death and dying, concerns about legal risk and poor communication skills. Second, the attributes of the patient and family, including their requests or demands for further treatment, prognostic uncertainty and lack of information about patient wishes. Third, there were hospital factors including a high degree of specialisation, the availability of routine tests and interventions, and organisational barriers to diverting a patient from a curative to a palliative pathway. Doctors nominated family or patient request and doctors being locked into a curative role as the main reasons for futile care.
  
  
  
  Doctors believe that a range of factors contribute to the provision of futile treatment. A combination of strategies is necessary to reduce futile treatment, including better training for doctors who treat patients at the end of life, educating the community about the limits of medicine and the need to plan for death and dying, and structural reform at the hospital level.
authors.affiliation: Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Lindy
authors.initials: L
authors.lastname: Willmott
authors.affiliation: Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: White
authors.affiliation: Faculty of Social and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Cindy
authors.initials: C
authors.lastname: Gallois
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Parker
authors.affiliation: Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Winch
authors.affiliation: Department of Internal Medicine, The Royal Brisbane and Womens Hospital, Herston, Queensland, Australia.
authors.forename: Leonie Kaye
authors.initials: LK
authors.lastname: Callaway
authors.affiliation: Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Shepherd
authors.affiliation: Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Eliana
authors.identifier: 0000-0002-7359-3375
authors.initials: E
authors.lastname: Close
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D003142:Communication; D003657:Decision Making; D026690:Ethics, Clinical; D006801:Humans; D018447:Medical Futility / Q000941:ethics; D010166:Palliative Care / Q000941:ethics; D010820:Physicians / Q000523:psychology; D011369:Professional-Patient Relations; D036301:Qualitative Research; D013727:Terminal Care / Q000941:ethics; D019452:Terminally Ill / Q000523:psychology*
keywords: Care of the Dying Patient; Decision-making; End of Life Care