Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Nonbeneficial Treatment Canada: Definitions, Causes, and Potential Solutions From the Perspective of Healthcare Practitioners*

Downar, James MDCM, MHSc1; You, John J. MD, MSc2; Bagshaw, Sean M. MD, MSc3; Golan, Eyal MD4; Lamontagne, Francois MD, MSc5; Burns, Karen MD, MSc6; Sridhar, S. Kavita MD, MHSc7; Seely, Andrew MD, PhD8; Meade, Maureen O. MD, MSc2; Fox-Robichaud, Alison MD, MSc9; Cook, Deborah MD, MSc2; Turgeon, Alexis F. MD, MSc10,11; Dodek, Peter MD, MHSc12; Xiong, Wei MSc13; Fowler, Rob MD, MS14on behalf of the Canadian Critical Care Trials Group

doi: 10.1097/CCM.0000000000000704
Feature Articles
Buy
SDC

Objective: Many healthcare workers are concerned about the provision of nonbeneficial treatment in the acute care setting. We sought to explore the perceptions of acute care practitioners to determine whether they perceived nonbeneficial treatment to be a problem, to generate an acceptable definition of nonbeneficial treatment, to learn about their perceptions of the impact and causes of nonbeneficial treatment, and the ways that they feel could reduce or resolve nonbeneficial treatment.

Design: National, bilingual, cross-sectional survey of a convenience sample of nursing and medical staff who provide direct patient care in acute medical wards or ICUs in Canada.

Main Results: We received 688 responses (response rate 61%) from 11 sites. Seventy-four percent of respondents were nurses. Eighty-two percent of respondents believe that our current means of resolving nonbeneficial treatment are inadequate. The most acceptable definitions of nonbeneficial treatment were “advanced curative/life-prolonging treatments that would almost certainly result in a quality of life that the patient has previously stated that he/she would not want” (88% agreement) and “advanced curative/life-prolonging treatments that are not consistent with the goals of care (as indicated by the patient)” (83% agreement). Respondents most commonly believed that nonbeneficial treatment was caused by substitute decision makers who do not understand the limitations of treatment, or who cannot accept a poor prognosis (90% agreement for each cause), and 52% believed that nonbeneficial treatment was “often” or “always” continued until the patient died or was discharged from hospital. Respondents believed that nonbeneficial treatment was a common problem with a negative impact on all stakeholders (> 80%) and perceived that improved advance care planning and communication training would be the most effective (92% and 88%, respectively) and morally acceptable (95% and 92%, respectively) means to resolve the problem of nonbeneficial treatment.

Conclusions: Canadian nurses and physicians perceive that our current means of resolving nonbeneficial treatment are inadequate, and that we need to adopt new techniques of resolving nonbeneficial treatment. The most promising strategies to reduce nonbeneficial treatment are felt to be improved advance care planning and communication training for healthcare professionals.

Supplemental Digital Content is available in the text.

1Divisions of Critical Care and Palliative Care, Department of Medicine, University of Toronto, Toronto, ON, Canada.

2Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.

3Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AL.

4Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada.

5Centre de Recherche Étienne-Le Bel, Université de Sherbrooke, Sherbrooke, QC, Canada.

6Interdepartmental Division of Critical Care, University of Toronto, and Keenan Research Centre and the Li KaShing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada.

7Department of Emergency Medicine and Critical Care, Lakeridge Health, Oshawa, ON, Canada.

8Departments of Surgery and Critical Care Medicine, Faculty of Medicine and Dentistry, University of Ottawa, Ottawa, ON, Canada.

9Department of Medicine, McMaster University, Hamilton, ON, Canada.

10Division of Critical Care, Department of Anesthesiology, Université Laval, Québec, QC, Canada

11Research Center of the Centre Hospitalier Universitaire (CHU) de Québec, Axe Santé des populations-Pratiques Optimales en Santé, Traumatologie-Urgence-Soins Intensifs, CHU de Québec (Hôpital de l’Enfant-Jésus), Université Laval, Québec City, QC, Canada.

12Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul’s Hospital and University of British Columbia, Vancouver, BC, Canada.

13Trauma, Emergency Medicine and Critical Care, Sunnybrook Hospital, Toronto, ON, Canada.

14Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada.

* See also p. 474.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. John You is supported by a Research Early Career Award from Hamilton Health Sciences. Dr. Sean M. Baghsaw is support by a Clinical Investigator Award from Alberta Innovates–Health Solutions and a Canada Research Chair in Critical Care Nephrology. Dr. Karen Burns holds a Clinician Scientist–Phase 2 Award from the Canadian Institutes of Health Research (CIHR). Dr. Alexis Turgeon is supported by a Research Career Award from the Fonds de la Recherche du Québec-Santé. Dr. Deborah Cook holds a Research Chair of the Canadian Institutes of Health Research. Dr. Bagshaw consulted and lectured for Gambro. Dr. Fox-Robichaud received support for travel from rCPSC (Examination Chair, Member Speciaty Committee, Member Assessment Committee). Her institution received grant support from CIHR (HALO translational study) and received support for development of educational presentations from SimOne/CPSI (Sepsis Education). Dr. Rob Fowler is supported by a Heart and Stroke Foundation Career Scientist Award. Dr. Fowler received grant support from the Department of Medicine Integrating Challenge Fund, University of Toronto. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: James Downar, MDCM, MHSc, 200 Elizabeth St 9N-926, Toronto, ON, Canada M5G 2C4. E-mail james.downar@utoronto.ca

Copyright © by 2015 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.