Advances in medicine have enabled critical-care specialists to save lives under extraordinary circumstances. Still, researchers say, admission to the ICU should be considered a “therapeutic trial,” and when aggressive critical care fails to achieve an acceptable state of health for the patient, the patient should be transitioned to palliative care.
While previous studies of ICU physicians in the U.S., Canada and Europe have shown that such futile care occurs, the UCLA-RAND team wanted to better quantify the frequency and expense of physician-perceived futile treatment in adult critical care. “Recognizing and quantifying the prevalence and cost of futile treatment are the first steps toward refocusing medical treatments to those that are more likely to benefit patients,” says pulmonologist and critical-care specialist Thanh Huynh, MD ’05 (RES ’08, FEL ’11).
“Futile treatment occurs in hospitals across the country. We have fantastic technology available in ICUs that saves lives, but we also need to address how to use it appropriately when the patient may not benefit from such high-intensity measures,” says Neil Wenger, MD ’84 (RES ’87, ’90, FEL ’89), director of the UCLA Healthcare Ethics Center and a consulting researcher with RAND.
The researchers analyzed 6,897 daily assessments of 1,125 patients over a three-month period. The team found that 904 patients (80 percent) did not receive futile treatment, 98 patients (9 percent) received probably futile treatment and 123 patients (11 percent) received futile treatment. The most common reason treatment was deemed futile was because the burdens of aggressive therapy grossly outweighed its potential benefit. Other reasons included: the treatment could never achieve the patient’s goals, death was imminent, the patient would never be able to survive outside of an ICU and the patient was permanently unconscious. For most patients, there was more than one reason his or her treatment was considered futile, the researchers said.
Of the 123 patients who received futile treatment, 85 percent died within six months, most of them during their hospitalization; the surviving patients were left in severely compromised health states and were often dependent on life-sustaining modalities. The average cost for a day of futile treatment in the ICU was about $4,000, the researchers found. For the 123 patients perceived as receiving futile ICU care, total costs during the three months of the study amounted to $2.6 million.
“The Frequency and Cost of Treatment Perceived to Be Futile in Critical Care,” JAMA Internal Medicine, September 9, 2013