(Reuters Health)—Doctors who were asked about causes of inappropriate care at the end of life didn’t have to look far to place blame. They blamed themselves.
Australian researchers interviewed 96 physicians from 10 medical specialties and asked them to describe situations when patients received end of life care that the doctors felt was inappropriate.
Futile medical treatment at the end of life has been shown to harm patients, cause moral distress to clinicians and waste scarce resources, as the researchers note May 17 in the Journal of Medical Ethics.
But 96% of physicians pointed to themselves—or “doctor-related factors”—as the main drivers of futile treatment. Poor communication, emotional attachment to patients and aversion to death were also among the causes they cited.
Patient-related factors were important, too. Ninety-one percent of the doctors cited such reasons as family or patient requests for treatment, prognostic uncertainty and not knowing the patient’s wishes as contributors to inappropriate care.
“The take-home message for patients and families is to have the conversation about what they want and don’t want at the end of life,” says study leader Dr. Lindy Willmott, of the Australian Centre for Health Law Research.
“Doctors’ natural tendency is to treat in this way, and to take another path requires one or more conversations with the patient and family,” Dr. Willmott tells Reuters Health. “Such conversations are difficult, and doctors are time-poor.”
Close to 70% of the surveyed doctors also cited hospital-related causes, such as specializations, medical hierarchy and time pressure, as factors in futile care.
It isn’t a matter of one doctor stepping back and considering the overall health of the patient, explains co-author Dr. Benjamin White, a law professor at the Queensland University of Technology.
“There are many specialists involved, each focused on a particular organ,” he tells Reuters Health. The narrow focus of the individual specialists can make it difficult to coordinate a patient’s care, he and his colleagues noted in their report.
Roughly one quarter of physicians said aggressive treatments are “hard to stop once started.”
The difficulty of withdrawing treatment is a challenge that’s all too common, agreed Dr. Eytan Szmuilowicz, a palliative care physician at Northwestern University’s Feinberg School of Medicine in Chicago.
Dr. Szmuilowicz, who was not associated with the study, added that doctors’ natural aversion to conflict complicates the issue further.
“We don’t know how to manage or negotiate it,” he tells Reuters Health. “It is easier behind the scenes to complain that a treatment may be inappropriate, but we haven’t taken a step back to think if we are providing care that furthers a patient’s goals.”