Translating futility

Kyriakopoulos, Paulina; Fedyk, Mark; Shamy, Michel

doi:10.1503/cmaj.161354

Cited by 6 publications

(6 citation statements)

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“…You see people die over and over again. It’s just like repetitive.” Another type of futility addressed was futile care, or medical treatment not likely to produce any meaningful benefit to the patient (Kyriakopoulos et al, 2017). One nurse stated, “I feel like these patients are lying here suffering, and we’re coding them, and we’re just intervening so much, when they are ultimately going to pass away.” Another nurse recounted,I remember being teary giving report, just thinking about all the things that we had been doing to this woman that seemed so unnecessary .…”

Section: Resultsmentioning

confidence: 99%

“…It's just like repetitive." Another type of futility addressed was futile care, or medical treatment not likely to produce any meaningful benefit to the patient (Kyriakopoulos et al, 2017). One nurse stated, "I feel like these patients are lying here suffering, and we're coding them, and we're just intervening so much, when they are ultimately going to pass away."…”

Section: Futilitymentioning

confidence: 99%

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Intensive Care Unit Nurses’ Lived Experiences of Psychological Stress and Trauma Caring for COVID-19 Patients

Levi

Moss

2022

Workplace Health Saf

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Background: Intensive care unit (ICU) nurses are enduring unprecedented burden caring for COVID-19 patients. Few studies have reported types of work-related events that lead to occupational stress and post-traumatic stress disorder (PTSD). Methods: ICU nurses were recruited at an academic health science center to explore their experiences of caring for COVID-19 patients. Participants were interviewed for 1 hour using open-ended questions. Symptoms of PTSD were assessed using the PTSD Checklist, job satisfaction with a Likert-type scale, and intention to leave their job with a “yes or no” question. Semi-structured interviews were transcribed and analyzed using NVivo software; quantitative data were analyzed using frequencies and means with R 4.0.5. Findings: The ICU nurse sample comprised nine females and one male, all Caucasian, with a mean age of 26.6 years. Analysis of interview transcripts revealed six recurring themes: Change in Practice, Emotion, Patient’s Family, Isolation, Job Satisfaction, and Public Reaction. Quantitative findings revealed 7 of 10 met diagnostic criteria for PTSD. Most participants (7/10) were “somewhat satisfied” with their job. Five of 10 considered leaving their job in the last 6 months. Conclusion/Implications for Practice: Understanding the impact stressful pandemic-related patient care has on ICU nurses provides evidence that new policies are needed. Furthermore, qualitative findings provide insight into the best design and deployment of interventions to reduce stress and prevent development of PTSD. More research is needed to understand long-term effects of PTSD and to evaluate strategies to prevent PTSD during stressful emergency surges in intensive care.

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Section: Resultsmentioning

confidence: 99%

Section: Futilitymentioning

confidence: 99%

Intensive Care Unit Nurses’ Lived Experiences of Psychological Stress and Trauma Caring for COVID-19 Patients

Levi

Moss

2022

Workplace Health Saf

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“…These situations have been described as non-beneficial, inappropriate or futile care, and merit evaluation as to the appropriateness of applying critical care resources. 2 - 4 The determination of futility in these cases is often based on qualitative assessment, rather than a purely physiologic one, 5 and encompasses judgment on achievable quality of life, potential harms, and the opportunity-cost of delivering the care. There are negative consequences to the delivery of critical care, such as physical and psychological pain inflicted on the patient, as well as psychological distress experienced by family members and staff.…”

Section: Introductionmentioning

confidence: 99%

Cost of Futile ICU Care in One Ontario Hospital

Schouela

Kyeremanteng

Thompson

et al. 2021

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Critical care is a costly and finite resource that provides the ability to manage patients with life-threatening illnesses in the most advanced forms available. However, not every condition benefits from critical care. There are unrecoverable health states in which it should not be used to perpetuate. Such situations are considered futile. The determination of medical futility remains controversial. In this study we describe the length of stay (LOS), cost, and long-term outcomes of 12 cases considered futile and that have been or were considered for adjudication by Ontario’s Consent and Capacity Board (CBB). A chart review was undertaken to identify patients admitted to the Intensive Care Unit (ICU), whose care was deemed futile and cases were considered for, or brought before the CCB. Costs for each of these admissions were determined using the case-costing system of The Ottawa Hospital Data Warehouse. All 12 patients identified had a LOS of greater than 4 months (range: 122-704 days) and a median age 83.5 years. Seven patients died in hospital, while 5 were transferred to long term or acute care facilities. All patients ultimately died without returning to independent living situations. The total cost of care for these 12 patients was $7 897 557.85 (mean: $658 129.82). There is a significant economic cost of providing resource-intensive critical care to patients in which these treatments are considered futile. Clinicians should carefully consider the allocation of finite critical care resources in order to utilize them in a way that most benefits patients.

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“…L’autonomie des patientes et patients n’est évidemment pas sans limites; par exemple, les médecins ne sont pas tenus de pratiquer des interventions physiologiquement futiles. Toutefois, la définition de la futilité est étroite: l’absence de toute possibilité d’efficacité biologique 5 . Elle implique donc une certitude de pronostic, chose plutôt rare.…”

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Établir la confiance : communication transparente et prise de décision partagée

Lamontagne

2024

CMAJ

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Translating futility

Cited by 6 publications

References 5 publications

Intensive Care Unit Nurses’ Lived Experiences of Psychological Stress and Trauma Caring for COVID-19 Patients

Intensive Care Unit Nurses’ Lived Experiences of Psychological Stress and Trauma Caring for COVID-19 Patients

Cost of Futile ICU Care in One Ontario Hospital

Établir la confiance : communication transparente et prise de décision partagée

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