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Abstract

Background:

Futile or potentially inappropriate care (futile/PIC) for dying inpatients leads to negative outcomes for patients and clinicians. In the setting of rising end-of-life health care costs and increasing physician burnout, it is important to understand the causes of futile/PIC, how it impacts on care and relates to burnout.

Objectives:

Examine causes of futile/PIC, determine whether clinicians report compensatory or avoidant behaviors as a result of such care and assess whether these behaviors are associated with burnout.

Design:

Online, cross-sectional questionnaire.

Setting/Subjects:

Clinicians at two academic hospitals in New York City.

Methods:

Respondents were asked the frequency with which they observed or provided futile/PIC and whether they demonstrated compensatory or avoidant behaviors as a result. A validated screen was used to assess burnout.

Measurements:

Descriptive statistics, odds ratios, linear regressions.

Results:

Surveys were completed by 349 subjects. A majority of clinicians (91.3%) felt they had provided or “possibly” provided futile/PIC in the past six months. The most frequent reason cited for PIC (61.0%) was the insistence of the patient's family. Both witnessing and providing PIC were statistically significantly (p < 0.05) associated with compensatory and avoidant behaviors, but more strongly associated with avoidant behaviors. Provision of PIC increased the likelihood of avoiding the patient's loved ones by a factor of 2.40 (1.82–3.19), avoiding the patient by a factor of 1.83 (1.32–2.55), and avoiding colleagues by a factor of 2.56 (1.57–4.20) (all p < 0.001). Avoiding the patient's loved ones (β = 0.55, SE = 0.12, p < 0.001), avoiding the patient (β = 0.38, SE = 0.17; p = 0.03), and avoiding colleagues (β = 0.78, SE = 0.28; p = 0.01) were significantly associated with burnout.

Conclusions:

Futile/PIC, provided or observed, is associated with avoidance of patients, families, and colleagues and those behaviors are associated with burnout.

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References

Kompanje

EJO

: Burnout, boreout and compassion fatigue on the ICU: It is not about work stress, but about lack of existential significance and professional performance. Intensive Care Med, 2018; 44:690–691.

Reddy

, O'Horo

, Hoskote

, Moua

: Judgment of futile care in the ICU. Crit Care Med, 2015; 43:e151.

Piers

, Azoulay

, Ricou

, et al.: Inappropriate care in European ICUs: Confronting views from nurses and junior and senior physicians. Chest, 2014; 146:267–275.

Eiferman

, Jones

: Of course, futile care is wasteful—Are we ready to act on this knowledge?. Crit Care Med, 2015; 43:e58–e59.

McNarry

, Goldhill

: Intensive care admission decisions for a patient with limited survival prospects: A questionnaire and database analysis. Intensive Care Med, 2004; 30:325–330.

Bosslet

, Kesecioglu

, White

: How should clinicians respond to requests for potentially inappropriate treatment?. Intensive Care Med, 2016; 42:422–425.

Piers

, Azoulay

, Ricou

, et al.: Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA, 2011; 306:2694–2703.

Meier

, Back

, Morrison

: The inner life of physicians and care of the seriously ill. JAMA, 2001; 286:3007–3014.

Niederman

, Berger

: The delivery of futile care is harmful to other patients. Crit Care Med, 2010; 38(10 Suppl):S518–S522.

10.

Huynh

, Kleerup

, Raj

, Wenger

: The opportunity cost of futile treatment in the ICU. Crit Care Med, 2014; 42:1977–1982.

11.

Damas

, Damas

, Lamy

: Euthanasia: A law in Belgium?. Intensive Care Med, 2001; 27:1683.

12.

Moss

, Good

, Gozal

, et al.: An official Critical Care Societies Collaborative Statement—Burnout syndrome in critical care health-care professionals: A Call for Action. Chest, 2016; 150:17–26.

13.

Lambden

, Chamberlin

, Kozlov

, et al.: Association of perceived futile or potentially inappropriate care with burnout and thoughts of quitting among health-care providers. Am J Hosp Palliat Care, 2018:1049909118792517.

14.

Huynh

, Kleerup

, Wiley

, et al.: The frequency and cost of treatment perceived to be futile in critical care. JAMA Intern Med, 2013; 173:1887–1894.

15.

Lanken

, Terry

, Osborne

: Ethics of allocating intensive care unit resources. New Horiz, 1997; 5:38–50.

16.

Cardona-Morrell

, Kim

, Turner

, et al.: Non-beneficial treatments in hospital at the end of life: A systematic review on extent of the problem. Int J Qual Health Care, 2016; 28:456–469.

17.

Emanuel

, Ash

, Yu

, et al.: Managed care, hospice use, site of death, and medical expenditures in the last year of life. Arch Intern Med, 2002; 162:1722–1728.

18.

Donnelly

, Dickson

: Relatives' matched with staff's experience of the moment of death in a tertiary referral hospital. QJM, 2013; 106:731–736.

19.

Schenker

, Crowley-Matoka

, Dohan

, et al.: I don't want to be the one saying ‘we should just let him die': Intrapersonal tensions experienced by surrogate decision makers in the ICU. J Gen Intern Med, 2012; 27:1657–1665.

20.

Willmott

, White

, Gallois

, et al.: Reasons doctors provide futile treatment at the end of life: A qualitative study. J Med Ethics, 2016; 42:496–503.

21.

Quill

, Arnold

, Back

: Discussing treatment preferences with patients who want “everything”. Ann Intern Med, 2009; 151:345–349.

22.

Nair-Collins

: Laying futility to rest. J Med Philos, 2015; 40:554–583.

23.

Schmoldt

, Freeborn

, Klevit

: Physician burnout: Recommendations for HMO managers. HMO Pract, 1994; 8:58–63.

24.

Rohland

: A survey of burnout among mental health center directors in a rural state. Adm Policy Ment Health, 2000; 27:221–237.

25.

Hansen

, Girgis

: Can a single question effectively screen for burnout in Australian cancer care workers?. BMC Health Serv Res, 2010; 10:341.

26.

Maslach

, Jackson

, Leiter

: Maslach Burnout Inventory: Test Manual, 3rd ed. In: CP Zalaquett and RJ Woods (eds.). Evaluating Stress: A Book of Resources. Lanham, MD: The Scarecrow Press, 1997, pp. 191–218.

27.

Makogon

, Enikolopov

: Problems with the assessment of shame and guilt. Psychology in Russia. http://psychologyinrussia.com/volumes/?article=2P13 (last accessed March 11, 2019).

28.

Elison

, Lennon

, Pulos

: Investigating the Compass of Shame: The development of the Compass of Shame Scale. Soc Behav Pers, 2006; 34:221–238.

29.

Stuewig

, Tangney

, Heigel

, et al.: Shaming, blaming, and maiming: Functional links among the moral emotions, externalization of blame, and aggression. J Res Pers, 2010; 44:91–102.

30.

Ferrell

: Understanding the moral distress of nurses witnessing medically futile care. Oncology Nurs Forum, 2006; 33:922–930.

31.

Palda

, Bowman

, McLean

, Chapman

: “Futile” care: Do we provide it? Why? A semistructured, Canada-wide survey of intensive care unit doctors and nurses. J Crit Care, 2005; 20:207–213.

32.

Glogowska

, Simmonds

, McLachlan

, et al.: “Sometimes we can't fix things”: A qualitative study of health care professionals' perceptions of end of life care for patients with heart failure. BMC Palliat Care, 2016; 15:3.

33.

Prigerson

, Jacobs

: Perspectives on care at the close of life. Caring for bereaved patients: “all the doctors just suddenly go”. JAMA, 2001; 286:1369–1376.

34.

Ahrens

, Yancey

, Kollef

: Improving family communications at the end of life: Implications for length of stay in the intensive care unit and resource use. Am J Crit Care, 2003; 12:317–323; discussion 324.

35.

Visser

, Deliens

, Houttekier

: Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: A systematic review. Crit Care, 2014; 18:604.

36.

Davidson

, Powers

, Hedayat

, et al.: Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005. Crit Care Med, 2007; 35:605–622.

37.

Nyman

, Sprung

: End-of-life decision making in the intensive care unit. Intensive Care Med, 2000; 26:1414–1420.

38.

Enguidanos

, Housen

, Penido

, et al.: Family members' perceptions of inpatient palliative care consult services: A qualitative study. Palliat Med, 2014; 28:42–48.

39.

Flannelly

, Emanuel

, Handzo

, et al.: A national study of chaplaincy services and end-of-life outcomes. BMC Palliat Care, 2012; 11:10.

40.

Balboni

, Paulk

, Balboni

, et al.: Provision of spiritual care to patients with advanced cancer: Associations with medical care and quality of life near death. J Clin Oncol, 2010; 28:445–452.

41.

Cunningham

, Quan

, Hemmelgarn

, et al.: Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol, 2015; 15:32.

42.

Kellerman

, Herold

: Physician response to surveys. A review of the literature. Am J Prev Med, 2001; 20:61–67.

Clinicians' Perceptions of Futile or Potentially Inappropriate Care and Associations with Avoidant Behaviors and Burnout

Abstract

Abstract

Background:

Objectives:

Design:

Setting/Subjects:

Methods:

Measurements:

Results:

Conclusions:

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References