'Wrong treatment': doctors’ take on medical futility in a low-resource ICU

Abstract

Background: Health caregivers in Intensive Care Units (ICUs) in developed countries have documented accounts of futile care for patients admitted into the Intensive Care Unit (ICU). But, evidence gaps exist in medical literature from developing countries on futility. While costs of establishing and running ICUs are astronomical in resource-poor countries, administration of medically futile care can further compound problems for ICU patients, family caregivers, health caregivers and hospital establishments. We sought and analysed the opinions of anaesthetists working in ICUs, highlighting the concept of medically futile care as perceived by health caregivers in low-middle income ICUs. Materials & Methods: Using a phenomenological framework, this study involved face-to-face in-depth interviews conducted with 15 resident doctors working in two ICUs of a tertiary health institution in South-East Nigeria. Transcripts were analysed using Interpretive Phenomenological Analysis (IPA). Results: Five core themes emerged: Unnecessary procedures and interventions; intrinsic and extrinsic factors of medically futile care; family caregiver influences; negative notions of medical futility; ICU outcomes. One participant was of the view that not intervening medically might be best for some patients admitted into the ICU. Other participants described cases where patients received care which participants considered futile, noted possible causes of futile treatments and proffered strategies to correct such situations. Conclusion: The surveyed doctors commonly view care to be futile in low-resource ICUs. Several factors are implicated including lack of goals in patient care, poor communication, lack of specialist training in intensive care and lack of protocols. Medical futility, in the opinion of these doctors, may contribute substantially to the challenges of running an ICU. This calls for multiple strategies for its reduction so as to ensure efficient use of scarce resources and improved outcomes in ICUs located in resource-limited settings.