Factors Influencing Potentially Futile Treatments at the End of Life in a Multiethnic Asian Cardiology Setting: A Qualitative Study

Abstract

Background. Modern medicine enables clinicians to save lives and prolong time to death, yet some treatments have little chance of conferring meaningful benefits for patients nearing the end-of-life. What clinicians perceive as driving futile treatment in the non-Western healthcare context is poorly understood. Aim. This study aimed to explore clinicians’ perceptions of the factors that influence futile treatment at the end of life within a tertiary hospital cardiac care setting. Design. We conducted semi-structured interviews with cardiologists, cardiac surgeons, and palliative care doctors from a large national cardiology center in Singapore. Interviews were transcribed verbatim and thematically analyzed. Results. A total of 32 clinicians were interviewed. We identified factors that contributed to the provision of potentially futile treatment in these theme areas: patient- and family-related, clinician-related, and institutional and societal factors. Family roles and cultural influences were most commonly cited by participants as affecting end-of-life decisions and altering the likelihood of futile treatment. Specialty-specific alignments within cardiology and availability of healthcare resources were also important factors underpinning futile treatment. Conclusion. Family-related factors were a primary driver for futile treatment in a non-Western, multicultural setting. Future interventions should consider a targeted approach accounting for cultural and contextual factors to prevent and reduce futile treatment.

Hearing, sharing and applying: a qualitative study of the experiences of family caregivers’ end-of-life decision-making in Singapore

“…The benefits of these interventions at advanced stages of illness may be distinct but minimal life extension, or come at a great cost to quality of life. 1 The behaviour of family caregivers in EOL decision-making in Singapore is influenced by Asian conceptualisations of filial piety, 2 where it is culturally acceptable to make EOL decisions with limited involvement from elderly parents to protect them from psychological distress 3 (which may, in turn, enhance the patient's quality of life). There also exists a persistent taboo in discussing 'inauspicious life events' such as illness, death and dying 4 and a prevalent 'worry about caregiver performance'-where caregivers fret about doing enough as caregivers.…”