An evolutionary concept analysis of futility in health care

AimTo report a concept analysis of futility in health care. BackgroundEach member of the healthcare team: the physician, the nurse, the patient, the family and all others involved perceive futility differently. The current evidence and knowledge in regard to futility in health care manifest a plethora of definitions, meanings and interpretations without consensus. DesignConcept analysis. Data SourcesDatabases searched included Medline, Cumulative Index of Nursing and Allied Health Literature, Academic Search Premier, Cochrane Database of Systematic Reviews and PsycINFO. Search terms included futil*, concept analysis, concept, inefficacious, non-beneficial, ineffective and fruitless from 1935-2016 to ensure a historical perspective of the concept. A total of 106 articles were retained to develop the concept. MethodsRogers' evolutionary concept analysis was used to evaluate the concept of futility from ancient medicine to the present. ResultsSeven antecedents (the patient/family autonomy, surrogate decision-making movement, the patient-family/physician relationship, physician authority, legislation and court rulings, catastrophic events and advancing medical technology) lead to four major attributes (quantitative, physiologic, qualitative, and disease-specific). Ultimately, futile care could lead to consequences such as litigation, advancing technology, increasing healthcare costs, rationing, moral distress and ethical dilemmas. ConclusionFutility in health care demonstrates components of a cyclical process and a consensus definition is proposed. A framework is developed to clarify the concept and articulate relationships among attributes, antecedents and consequences. Further testing of the proposed definition and framework are needed.