Age as a Deciding Factor in the Consideration of Futility for a Medical Intervention in Patients Among Internal Medicine Physicians in Two Practice Locations

Abstract

This study explores physicians' concepts of futility and use of age as a deciding factor in considering medical futility in clinical interventions. Survey. Five academic hospitals in the United States. Participants were 355 internal medicine physicians, including 162 residents, 98 fellows, and 95 attending physicians. Anonymous questionnaire in which respondents were asked to define futility and to rate patient scenarios as futile or not, unaware that these were pairs of patient scenarios with similar clinical severity and treatment, but different age. Forty-five percent (n = 159) of physicians used the most accepted definition of futility in the literature: "a therapy that will not benefit the patient in attaining a specific goal." Physicians rated patient scenarios as futile for 58% of elder (> or =65 years) and for 59% of nonelder (<65 years) cases (P = .21). By training level, resident physicians rated more elder cases as futile (60%) than fellow/attending physicians (56%, P = .03). Rating of medical futility did not differ by practice location (59% in Missouri and 59% in Puerto Rico, P = .13). Physicians did not use age as a factor in deciding the futility of a medical intervention. In patient scenarios with comparable clinical severity of illness, medical interventions were similarly rated as futile in elder and nonelder persons. Less-experienced physicians (residents) were more likely to rate elder cases as futile compared with experienced physicians (attending/fellows).