The frequency and cost of treatment perceived to be futile in critical care

Journal article


Huynh, Thanh, Kleerup, Eric, Wiley, Joshua, Savitsky, Terrance, Guse, Diana, Garber, Bryan and Wenger, Neil. (2013). The frequency and cost of treatment perceived to be futile in critical care. JAMA Internal Medicine (print). 173(20), pp. 1887 - 1894. https://doi.org/10.1001/jamainternmed.2013.10261
AuthorsHuynh, Thanh, Kleerup, Eric, Wiley, Joshua, Savitsky, Terrance, Guse, Diana, Garber, Bryan and Wenger, Neil
Abstract

Importance: Physicians often perceive as futile intensive care interventions that prolong life without achieving an effect that the patient can appreciate as a benefit. The prevalence and cost of critical care perceived to be futile have not been prospectively quantified. Objective: To quantify the prevalence and cost of treatment perceived to be futile in adult critical care. Design, Setting, and Participants: To develop a common definition of futile care, we convened a focus group of clinicians who care for critically ill patients. On a daily basis for 3 months, we surveyed critical care specialists in 5 intensive care units (ICUs) at an academic health care system to identify patients whom the physicians believed were receiving futile treatment. Using a multivariate model, we identified patient and clinician characteristics associated with patients perceived to be receiving futile treatment. We estimated the total cost of futile treatment by summing the charges of each day of receiving perceived futile treatment and converting to costs. Main Outcome and Measure: Prevalence of patients perceived to be receiving futile treatment. Results: During a 3-month period, there were 6916 assessments by 36 critical care specialists of 1136 patients. Of these patients, 904 (80%) were never perceived to be receiving futile treatment, 98 (8.6%) were perceived as receiving probably futile treatment, 123 (11%) were perceived as receiving futile treatment, and 11 (1%) were perceived as receiving futile treatment only on the day they transitioned to palliative care. The patients with futile treatment assessments received 464 days of treatment perceived to be futile in critical care (range, 1-58 days), accounting for 6.7% of all assessed patient days in the 5 ICUs studied. Eighty-four of the 123 patients perceived as receiving futile treatment died before hospital discharge and 20 within 6 months of ICU care (6-month mortality rate of 85%), with survivors remaining in severely compromised health states. The cost of futile treatment in critical care was estimated at $2.6 million. Conclusions and Relevance: In 1 health system, treatment in critical care that is perceived to be futile is common and the cost is substantial.

Year2013
JournalJAMA Internal Medicine (print)
Journal citation173 (20), pp. 1887 - 1894
ISSN2168-6106
Digital Object Identifier (DOI)https://doi.org/10.1001/jamainternmed.2013.10261
Page range1887 - 1894
Publisher's version
File Access Level
Controlled
Permalink -

https://acuresearchbank.acu.edu.au/item/85412/the-frequency-and-cost-of-treatment-perceived-to-be-futile-in-critical-care

Restricted files

Publisher's version

  • 108
    total views
  • 0
    total downloads
  • 0
    views this month
  • 0
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

Impact of body mass index on mortality and hospitalisation of patients with atrial fibrillation
Ball, Jocasta, Loechen, Maja-Lisa, Carrington, Melinda, Wiley, Joshua and Stewart, Simon. (2018). Impact of body mass index on mortality and hospitalisation of patients with atrial fibrillation. European Journal of Cardiovascular Nursing. 17(7), pp. 627 - 636. https://doi.org/10.1177/1474515118772446
Mild cognitive impairment impacts health outcomes of patients with atrial fibrillation undergoing a disease management intervention
Ball, Jocasta, Løchen, Maja-Lisa, Carrington, Melinda J., Wiley, Joshua and Stewart, Simon. (2018). Mild cognitive impairment impacts health outcomes of patients with atrial fibrillation undergoing a disease management intervention. Open Heart (online). 5(1), p. Article e000755. https://doi.org/10.1136/openhrt-2017-000755
Multimorbidity and the risk of all-cause 30-day readmission in the setting of multidisciplinary management of chronic heart failure: A retrospective analysis of 830 hospitalized patients in Australia
Wiley, Joshua F., Chan, Yih-Kai, Ahamed, Yasmin, Ball, Jocasta, Carrington, Melinda J., Reigel, Barbara and Stewart, Simon. (2018). Multimorbidity and the risk of all-cause 30-day readmission in the setting of multidisciplinary management of chronic heart failure: A retrospective analysis of 830 hospitalized patients in Australia. Journal of Cardiovascular Nursing. 33(5), pp. 437 - 445. https://doi.org/10.1097/JCN.0000000000000391
Blood glucose levels and glycaemic burden in 76,341 patients attending primary care: Bittersweet findings from a 9-year cohort study
Carrington, Melinda, Cohen, Neale and Wiley, Joshua. (2017). Blood glucose levels and glycaemic burden in 76,341 patients attending primary care: Bittersweet findings from a 9-year cohort study. Diabetes Research and Clinical Practice. 127, pp. 89 - 96. https://doi.org/10.1016/j.diabres.2017.02.030
Relationship of psychosocial resources with allostatic load : A systematic review
Wiley, Joshua F., Bei, Bei, Bower, Julienne E. and Stanton, Annette L.. (2017). Relationship of psychosocial resources with allostatic load : A systematic review. Psychosomatic Medicine. 79(3), pp. 283-292. https://doi.org/10.1097/PSY.0000000000000395
Sleep and physiological dysregulation: a closer look at sleep intraindividual variability
Bei, Bei, Seeman, Teresa E., Carroll, Judith E. and Wiley, Joshua. (2017). Sleep and physiological dysregulation: a closer look at sleep intraindividual variability. Sleep. 40(9), pp. 1 - 10. https://doi.org/10.1093/sleep/zsx109
Beyond the mean: A systematic review on the correlates of daily intraindividual variability of sleep/wake patterns
Bei, Bei, Wiley, Joshua F., Trinder, John and Manber, Rachel. (2016). Beyond the mean: A systematic review on the correlates of daily intraindividual variability of sleep/wake patterns. Sleep Medicine Reviews. https://doi.org/10.1016/j.smrv.2015.06.003
Impact of nurse-led, multidisciplinary home-based intervention on event-free survival across the spectrum of chronic heart disease: Composite analysis of health outcomes in 1226 patients from 3 randomized trials
Stewart, Simon, Wiley, Joshua F., Ball, Jocasta Clare, Chan, Yih-Kai, Ahamed, Yasmin, Thompson, David Robert and Carrington, Melinda Jane. (2016). Impact of nurse-led, multidisciplinary home-based intervention on event-free survival across the spectrum of chronic heart disease: Composite analysis of health outcomes in 1226 patients from 3 randomized trials. Circulation. 133(19), pp. 1867 - 1877. https://doi.org/10.1161/CIRCULATIONAHA.116.020730
Is the last man standing in comedy the least funny? A retrospective cohort study of elite stand-up comedians versus other entertainers
Stewart, Simon, Wiley, Joshua F., McDermott, Cressida J. and Thompson, David Robert. (2016). Is the last man standing in comedy the least funny? A retrospective cohort study of elite stand-up comedians versus other entertainers. International Journal of Cardiology. 220, pp. 789 - 793. https://doi.org/10.1016/j.ijcard.2016.06.284
A metabolic syndrome severity score: A tool to quantify cardio-metabolic risk factors
Wiley, Joshua and Carrington, Melinda Jane. (2016). A metabolic syndrome severity score: A tool to quantify cardio-metabolic risk factors. Preventive Medicine. 88, pp. 189 - 195. https://doi.org/10.1016/j.ypmed.2016.04.006
Modeling multisystem physiological dysregulation
Wiley, Joshua F., Gruenewald, Tara L., Karlamangha, Arun S. and Seeman, Teresa E.. (2016). Modeling multisystem physiological dysregulation. Psychosomatic Medicine. 78(3), pp. 290-301. https://doi.org/10.1097/PSY.0000000000000288
A parietal biomarker for ADHD liability : As predicted by the distributed effects perspective model of ADHD
Sigi Hale, T, Wiley, Joshua, Smalley, Susan, Tung, Kelly, Kaminsky, Olivia, McGough, James, Jaini, Ashwin and Loo, Sandra. (2015). A parietal biomarker for ADHD liability : As predicted by the distributed effects perspective model of ADHD. Frontiers in Psychiatry. 6(63), pp. 1 - 19. https://doi.org/10.3389/fpsyt.2015.00063
Differences between attendings' and fellows' perceptions of futile treatment in the intensive care unit at one academic health center : Implications for training
Neville, Thanh, Wiley, Joshua, Holmboe, Eric, Tseng, Chi-Hong, Vespa, Paul, Kleerup, Eric and Wenger, Neil. (2015). Differences between attendings' and fellows' perceptions of futile treatment in the intensive care unit at one academic health center : Implications for training. Academic Medicine. 90(3), pp. 324 - 330. https://doi.org/10.1097/ACM.0000000000000617
A cognitive vulnerability model of sleep and mood in adolescents under naturalistically restricted and extended sleep opportunities
Bei, Bei, Wiley, Joshua F., Allen, Nicholas B. and Trinder, John. (2015). A cognitive vulnerability model of sleep and mood in adolescents under naturalistically restricted and extended sleep opportunities. Sleep. 38(3), pp. 453 - 461. https://doi.org/10.5665/sleep.4508
Online dating across the life span: Users' relationship goals
Menkin, Josephine A., Robles, Theodore F., Wiley, Joshua and Gonzaga, Gian C.. (2015). Online dating across the life span: Users' relationship goals. Psychology and Aging. 30(4), pp. 987 - 993. https://doi.org/10.1037/a0039722
Depressive episodes, symptoms, and trajectories in women recently diagnosed with breast cancer
Stanton, Annette, Wiley, Joshua, Krull, Jennifer, Crespi, Catherine, Hammen, Constance, Allen, John, Barron, Martha, Jorge, Alexandra and Weihs, Karen. (2015). Depressive episodes, symptoms, and trajectories in women recently diagnosed with breast cancer. Breast Cancer Research and Treatment. 154(1), pp. 105 - 115. https://doi.org/10.1007/s10549-015-3563-4
Cancer and mental health
Wiley, Joshua and Stanton, A. L.. (2015). Cancer and mental health. In In H. S. Friedman (Ed.). Encyclopedia of mental health pp. 228 - 232 Academic Press. https://doi.org/10.1016/B978-0-12-397045-9.00150-6
How stress gets under the skin o como el estres psicologico se introduce bajo la piel
Ortiz, Manuel S., Wiley, Joshua F. and Chiang, Jessica J.. (2014). How stress gets under the skin o como el estres psicologico se introduce bajo la piel. Revista Medica de Chile. 142(6), pp. 767 - 774. https://doi.org/10.4067/S0034-98872014000600011
Visual network asymmetry and default mode network function in ADHD : An fMRI study
Hale, T., Kane, Andrea, Kaminsky, Olivia, Tung, Kelly, Wiley, Joshua, McGough, James, Loo, Sandra and Kaplan, Jonas. (2014). Visual network asymmetry and default mode network function in ADHD : An fMRI study. Frontiers in Psychiatry (online). 5(81), pp. 1 - 20. https://doi.org/10.3389/fpsyt.2014.00081
Visual network asymmetry and default mode network function in ADHD : An fMRI study
Hale, T. Sigi, Kane, Andrea M., Kaminsky, Olivia, Tung, Kelly L., Wiley, Joshua F., McGough, James J., Loo, Sandra K. and Kaplan, Jonas T.. (2014). Visual network asymmetry and default mode network function in ADHD : An fMRI study. Frontiers in Psychiatry. 5(81), pp. 1 - 20. https://doi.org/10.3389/fpsyt.2014.00081
Changes in self-efficacy and outcome expectancy as predictors of anxiety outcomes from the CALM study
Brown, Lily A., Wiley, Joshua F., Wolitzky-Taylor, Kate, Roy-Byrne, Peter, Sherbourne, Cathy, Stein, Murray B., Sullivan, Greer, Rose, Raphael D., Bystritsky, Alexander and Craske, Michelle G.. (2014). Changes in self-efficacy and outcome expectancy as predictors of anxiety outcomes from the CALM study. Depression and Anxiety. 31(8), pp. 678 - 689. https://doi.org/10.1002/da.22256
The Child Anxiety Impact Scale : Examining parent-and child-reported impairment in child anxiety disorders
Langley, Audra, Falk, Avital, Peris, Tara, Wiley, Joshua, Kendall, Philip, Ginsburg, Golda, Birmaher, Boris, March, John, Albano, Ann Marie and Piacentini, John. (2014). The Child Anxiety Impact Scale : Examining parent-and child-reported impairment in child anxiety disorders. Journal of Clinical Child and Adolescent Psychology. 43(4), pp. 579 - 591. https://doi.org/10.1080/15374416.2013.817311
The Child Anxiety Impact Scale: Examining Parent- and Child-Reported Impairment in Child Anxiety Disorders
Langley, Audra K., Falk, Avital, Peris, Tara, Wiley, Joshua F., Kendall, Philip C., Ginsburg, Golda, Birmaher, Boris, March, John, Albano, Ann Marie and Piacentini, John. (2014). The Child Anxiety Impact Scale: Examining Parent- and Child-Reported Impairment in Child Anxiety Disorders. Journal of Clinical Child and Adolescent Psychology. 43(4), pp. 579 - 591. https://doi.org/10.1080/15374416.2013.817311
Perceived social support mediates anxiety and depressive symptom changes following primary care intervention
Dour, Halina J., Wiley, Joshua F., Roy-Byrne, Peter, Stein, Murray B., Sullivan, Greer, Sherbourne, Cathy D., Bystritsky, Alexander, Rose, Raphael D. and Craske, Michelle G.. (2014). Perceived social support mediates anxiety and depressive symptom changes following primary care intervention. Depression and Anxiety. 31(5), pp. 436 - 442. https://doi.org/10.1002/da.22216
The frequency and cost of treatment perceived to be futile in critical care
Huynh, Thanh, Kleerup, Eric, Wiley, Joshua F., Savitsky, Terrance, Guse, Diana, Garber, Bryan and Wenger, Neil. (2013). The frequency and cost of treatment perceived to be futile in critical care. JAMA Internal Medicine. 173(20), pp. 1887 - 1894. https://doi.org/10.1001/jamainternmed.2013.10261
Quality of life and cancer-related needs in patients with choroidal melanoma
Wiley, Joshua F., Laird, Kelsey, Beran, Tammy, McCannel, Tara and Stanton, Annette. (2013). Quality of life and cancer-related needs in patients with choroidal melanoma. British Journal of Ophthalmology. 97(11), pp. 1471 - 1474. https://doi.org/10.1136/bjophthalmol-2013-303635
Quality of life and cancer-related needs in patients with choroidal melanoma
Wiley, Joshua, Laird, Kelsey, Beran, Tammy, McCannel, Tara and Stanton, Annette. (2013). Quality of life and cancer-related needs in patients with choroidal melanoma. British Journal of Ophthalmology. 97(11), pp. 1471 - 1474. https://doi.org/10.1136/bjophthalmol-2013-303635