“Do resuscitate me but no futile care”: The use of the formula « futile care » in medical interviews

V. Wenger¹, E. Rubli Truchard¹, O. Weber¹, J. Jacquin¹, A. Sterie¹ (¹Lausanne)

Hintergrund

Conversations about cardio-pulmonary resuscitation (CPR) are compulsory and important in hospital admission for older people. Physicians are required to indicate whether CPR is medically indicated and document the patients’ preferences. Discussing end of life is a delicate task which requires skills (Rubli Truchard et al. 2017; Ferré Ibáñez et al. 2019). Ambiguous terms such as reference to “futile” or “aggressive” treatment in association to CPR can generate confusion (Jox et al. 2012).

Ziel

To examine the impact of the formula “futile (medical) care” (« acharnement thérapeutique ») in medical interviews about patients’ CPR preferences in case of complications such as cardiorespiratoiry arrest.

Methode

A qualitative study of 12 discussions about resuscitation preferences containing the formula « futile (medical) care ». Consultations were recorded in a rehabilitation center for elderly persons in francophone Switzerland and transcribed and analyzed using conversation analysis. Every occurrence has been analyzed regarding its function, its place in the conversation and the reactions it generates. The definitions suggested for the formula, formulated by patients and physicians during consultations, have also been observed.

Resultate

The formula is not always used with the same meaning. Patients often use “no futile care” to indicate that they do not want disproportionate treatments resulting in undesirable health conditions. This can however mean “no CPR”, or a reasonable degree of “CPR” and physicians sometimes lack to ask for clarification. In other cases, the formula is followed by discussions to clarify its meaning and leads to reliable discussions on CPR.

Schlussfolgerung

The formula is useful to facilitate communication to a certain extent, but different understandings of what it stands for can generate misunderstanding. Clarifications are necessary to be sure that the right information is transmitted. The conversations where the formula is not questioned or discussed leave a doubt and can generate errors and have serious repercussions on the quality of care provided. An agreement on the terms and their significations is important so the autonomy of the patient can be respected.