Perceptions of medical futility in clinical practice - A qualitative systematic review

Purpose: To summarize and compare qualitative studies which explored attitudes of patients, families and healthcare providers towards medical futility. Materials and methods: A systematic search of qualitative studies via the PubMed database was conducted. Data were extracted in terms of two aspects: 1) Group of people, which were interviewed about futility; 2) Definitions of medical futility given by these participants. Data were analyzed and synthesized using the method of qualitative content analysis. Results: The initial search identified 737 articles. 71 studies were reviewed in detail and 10 were finally selected. As a result, three groups of people (physicians, caregiver and patients) and six core categories could be identified: patient treatment, quantitative aspects, resources, professional aspects, reference to balance, definition challenges. Conclusions: This review describes existing opinions about medical futility and demonstrates the multifaceted understanding of medical futility by physicians, caregivers and patients. The difficulties in defining medical futility demonstrate the need for resources to help healthcare providers and patients to deal with decision-making in such situations. (C) 2018 Elsevier Inc. All rights reserved.