Therapeutic Futility Research Articles

Futile therapeutic nursing interventions in adult intensive care: A descriptive study.

Background: Despite the progress made in recent decades on the phenomenon of futility in adult intensive care, recognizing it during clinical care practice remains a complex and sensitive process, during which questions are often raised for which concrete answers are difficult to find. Aims: To analyze the frequency with which futile nursing interventions are implemented in critically ill patients admitted to adult intensive care in specific situations and how often futile autonomous and interdependent nursing interventions are implemented in the same population, as perceived by adult intensive care nurses. Research design: Cross-sectional, quantitative, and descriptive study, which employed a questionnaire constructed specifically for this research to assess the perception of therapeutic futility in nursing in adult intensive care. Following an evaluation of the psychometric properties, the questionnaire was made available in an electronic format on the EUSurvey platform between August and October 2024. The data was analyzed between November 2023 and March 2024 using the statistical software packages SPSS and R. Participants and research context: A simple random sample of nurses working in level II and level III intensive care units in Portugal. Ethical considerations: Research ethical approvals were obtained, and the participants provided informed consent. Findings/results: Four hundred and fourteen valid questionnaires were obtained. The results allow the identification of thirty-three statistically significant associations, the inference of intervals for the mean and median for the perception of futility of nursing interventions with a 95% confidence interval, and enable the hierarchization of nursing interventions implemented in critically ill patients admitted to adult intensive care units according to the nurses' perception of their futility. Conclusion: There is a balance in nurses' perception of the futility of their interventions in the specific situations analyzed. There is statistically significant evidence that interdependent nursing interventions are, in general, more frequently perceived as futile when compared to autonomous nursing interventions.

Physician assisted dying : A French Perspective - a new revolution?

AbstractThe debates on euthanasia and assisted suicide (EAS) are topical in Europe. The extension of EAS for psychiatric reasons, already legalized in some countries, raises ethical and clinical issues, given the proximity between suicidal patients and patients who request or have accessed EAS. How can ESA be reconciled with the promotion of suicide prevention, which kills nearly 10,000 people per year in France? We will raise here several key questions that deserve a clear answer before considering going further in the social debates: how to ensure the irreversibility of psychological suffering? how to ensure that patients requesting EAS have full decision-making capacity? how to judge therapeutic futility? It seems crucial to protect the most vulnerable patients by ensuring that psychiatry benefits from scientific progress and can offer new solutions to suffering patients.Thes issues will be discussed viewing the proposed law on EAS in France, which is supposed to come in February 2024…Disclosure of InterestNone Declared

Portuguese Advance Directives-a twist against futility? A cross sectional study.

Advance Directive documents allow citizens to choose the treatments they want for end-of-life care without considering therapeutic futility. To analyze patients' and caregivers' answers to Advance Directives and understand their expectations regarding their decisions. This study analyzed participants' answers to a previously published trial, conceived to test the document's efficacy as a communication tool. Sixty palliative patients and 60 caregivers (n=120) registered their preferences in the Advance Directive document and expressed their expectations regarding whether to receive the chosen treatments. In the patient and caregiver groups, 30% and 23.3% wanted to receive cardiorespiratory resuscitation; 23.3% and 25% wanted to receive artificial organ support; and 40% and 35% chose to receive artificial feeding and hydration, respectively. The participants ignored the concept of therapeutic futility and expected to receive invasive treatments. The concept of therapeutic futility should be addressed and discussed with both the patients and caregivers. Legal Advanced Directive documents should be made clear to reduce misinterpretations and potential legal conflicts. The authors suggest that all citizens should be clarified regarding the futility concept before filling out the Advance Directives and propose a grammatical change in the document, replacing the phrase "Health Care to Receive / Not to Receive" with the sentence "Health Care to Accept / Refuse" so that patients cannot demand treatments, but instead accept or refuse the proposed therapeutic plans. ClinicalTrials.gov ID NCT05090072. https://clinicaltrials.gov/ct2/show/NCT05090072.

Identifying Early Suboptimal Hematological Response in Patients with AL Amyloidosis Treated with Bortezomib-Based Chemotherapy

Background: Achievement of rapid and deep hematological responses is critical in the treatment of AL amyloidosis, particularly for those patients with advanced cardiac involvement. The timing and depth of FLC reduction that defines suboptimal response and the need to switch to second-line therapy is uncertain. We aimed to determine the impact of hematological response after 2 months of bortezomib-based therapy on subsequent best hematological and organ responses and survival in patients with and without advanced cardiac disease. Methods: The cohort was derived from three amyloidosis centres in Australia (Brisbane, Perth and Sydney). Patients were identified with a diagnosis of AL amyloidosis, symptomatic organ involvement and initial treatment with a bortezomib-based regimen. The impact of hematological response after 2 months of treatment on subsequent best hematological, cardiac and renal response was assessed using Fisher's exact test. The impact on OS was assessed by landmark analysis using log-rank or Cox regression analysis. Organ involvement and response criteria were as per International Society of Amyloidosis recommendations. Results: 190 patients with AL amyloidosis were identified: Median age was 66 yrs and 38% were male. 74% of cases were lambda restricted, the median dFLC was 170mg/L, the median bone marrow plasmacytosis was 11% and 7% had symptomatic myeloma. Mayo 2004 cardiac stage was: 1 (14%), 2 (47%), 3A (23%) and 3B (16%). 69% had renal involvement with a median eGFR of 70mls/min and median proteinuria of 1.9g/d , with 7% dialysis dependent at presentation. Liver involvement was present in 16% and peripheral neuropathy in 27%. Bortezomib regimens were: VCD (75%), VCD+daratumumab (13%), MDV (5%), VD (5%) and VRD (2%), with a median of 6 cycles delivered (range 1-16). Median OS was 6.2 years which was adversely associated with more advanced cardiac disease: stage 1 (not reached), stage 2 (90 months), stage 3A (74 months) and stage 3B (24 months)(p=0.0001). Hematological response after 2 months of bortezomib-based induction was: CR (17%), VGPR (39%), PR (19%) and less than PR (13%). 9% of patients died prior to the 2 month response assessment and 5 patients (2%) had missing data. Failure to achieve PR by 2 months was associated with a low chance of achieving deep responses, with only 16% going on to achieve VGPR or better (p<0.001). Similarly, failure to achieve PR by 2 months predicted a low likelihood of improving organ function with less chance of cardiac (6% vs 56%, p=0.001) and renal (30% vs 46%, p=0.097) responses. In a landmark analysis, failure to achieve PR after 2 months predicted worse OS (median 31 vs 88 months, p=0.001), a finding confirmed in multivariate analysis including cardiac stage and age. Failure to achieve VGPR by 2 months was also associated with a lower likelihood of achieving subsequent deep hematological responses and organ responses but 38% still managed to achieve VGPR or better by the completion of therapy and 31% a cardiac response. When analysed among patients with Mayo Stage 3A or 3B cardiac disease (i.e. advanced cardiac involvement), however, failure to achieve VGPR by 2 months was associated with reduced likelihood of cardiac response (25% vs 61%, p<0.001) and worse overall survival (median OS 30 vs 72 months, p<0.001). In contrast, among patients with cardiac stage 1 or 2 disease, failure to achieve VGPR by 2 months was associated with a trend to reduced cardiac responses (35% vs 58%, p=0.083) but not overall survival (median 78 vs 96 months, p=0.224) Conclusion: Failure to achieve hematological PR after 2 months of bortezomib-based therapy defines a high chance of therapeutic failure in AL amyloidosis and such patients should be switched to alternate salvage therapy. In patients with advanced cardiac stage 3A and 3B disease rapid, deep responses are required and failure to achieve VGPR after 2 cycles also predicts poor cardiac response and survival and defines a suboptimal response. Failure to achieve VGPR by 2 months in patients with cardiac stage 1 or 2 disease, however, was not associated with therapeutic futility.

Racial disparities and inequity in clinical trials of chimeric antigen receptor T-cell therapy.

e18515 Background: Chimeric antigen receptor (CAR) T-cell therapy is a paradigm-shifting advancement in hematologic malignancies with therapeutic futility. There is growing evidence that there are disparities affecting race and ethnicity for malignancy treatments as well as under-representation of minorities in clinical trials. We analyzed the racial representation in clinical trials of CAR-T products in the US. Methods: We searched all clinical trials in PubMed for six FDA-approved CAR-T therapy for all indications. We included all phase 2 and above published trials that were conducted in the US and recorded demographic data. Results: Out of total 64 studies; 16 were included for final analysis. A total of 1678 patients enrolled in the CAR-T therapy trials. The table shows indication and demographic data of the patient. Only 9 (56%) articles reported race and 8 (50%) articles reported ethnicity. We found only 47 (3%) African Americans, 47 (3%) Asian races, and 53 (3%) Hispanic ethnicity patients were enrolled in the trials. Conclusions: Our study highlights inadequate reporting of race/ethnicity and continued under-representation of minorities in clinical trials. This is the largest study examining the generalizability of CAR-T cell therapy RCTs at a population level. The underrepresentation in RCTs is an alarming finding as the incidence of many of the diseases is quite high in such minority populations thus exposing a significant disparity in health equity and healthcare access. More insights through research and policymaking are necessary to overcome barriers to delivering equitable healthcare, especially to underrepresented minorities.[Table: see text]

Health-related experiences of adults with chronic cough: Empirical research mixed methods.

To describe adults' health-related experiences with chronic cough. Survey and interviews. Participants completed questionnaires and interviews, to explore chronic cough's impact and management. Patients aged 18-85 years with at least three cough-related encounters within 56-120 days. Forty-one patients were surveyed. Mean cough severity was 4.5 (scale 0-9). Chronic cough-related problems included embarrassment (66%), fatigue (56%), and anxiety or depression (49%). Testing was judged insufficient by 44%. Only 28% were satisfied with treatment; 20% reported abandoning treatment due to ineffectiveness. Interview themes (N=30) included frustration with diagnostic uncertainty, and feelings of therapeutic futility. Some reported psychological distress. Work and socializing were commonly disrupted. Diagnostic uncertainty, perceived limitations of testing, and treatment failures suggest needs for better approaches to evaluating and treating chronic cough. Special attention to identifying and addressing mental health issues appears warranted.

<br/> A NECESSIDADE DA LITERACIA EM SAÚDE SOBRE OS CUIDADOS PALIATIVOS <br/>

Palliative care should be available to all people with chronic and life-threatening illnesses, but despite all the efforts of the Portuguese Association of Palliative Care and the National Commission for Palliative Care, there are still Portuguese people with palliative needs who do not have access to these. One of the recommendations of the Strategic Plans for the Development of Palliative Care (PEDCP) is that the curricular unit of palliative care be integrated into all pre-graduate training courses in the area of health so that health professionals may be provided with basic training in palliative care. In addition to this recommendation, palliative care should be incorporated into all levels of care to which the population has access in Portugal, Primary Health Care (CSP), Hospital Health Care (CSH) and Integrated Long-term Care (CCI), the greater the involvement of all stakeholders through collective and social action, the more effective this may become. Thus, palliative care reduces the length of hospital stay, readmissions, therapeutic futility, the use of emergency services and intensive care, and, consequently, decreases health costs. Therefore, this article aims to outline a health literacy plan for palliative care for the Portuguese population residing in Portugal.

Decisions concerning resuscitation and end-of-life care in neonates. Bioethical aspects (Part II).

Coping with the death of a newborn infant requires training and reflection regarding the end-of-life decision-making process, communication with the family, and the care to be provided. The objective of this article is to analyze in depth the salient aspects of neonatal bioethics applied to end-of-life situations in newborn infants. Part I describes notions of therapeutic futility, redirection of care criteria, patient and family rights, and concepts about the value of life. Part II analyzes situations that deserve considering the redirection of care and delves into aspects of communication and the complex process of end-of-life decision-making in newborn infants.

Decisions concerning resuscitation and end-of-life care in neonates. Bioethical aspects (Part I).

Coping with the death of a newborn infant requires training and reflection regarding the end-of-life decision-making process, communication with the family, and the care to be provided. The objective of this article is to analyze in depth the salient aspects of neonatal bioethics applied to end-of-life situations in newborn infants. Part I describes notions of therapeutic futility, redirection of care criteria, patient and family rights, and concepts about the value of life. Part II analyzes situations that deserve considering the redirection of care and delves into aspects of communication and the complex process of end-of-life decision-making in newborn infants.

Transcatheter Tricuspid Valve Repair in Prohibitive Risk Patients: Impact on Quality of Life and Major Organ Systems

BackgroundPercutaneous repair for severe tricuspid regurgitation (TR) is emerging as a viable option, but patient selection is challenging and predetermined by comorbidities. This study evaluated mid-term outcomes of transcatheter tricuspid valve repair (TTVR) in very sick inoperable patients and explored the concept of risk-based therapeutic futility. MethodsTTVR patients treated in our centre were prospectively assigned to prohibitive-risk (PR) and high-risk (HR) subgroups, based on Society of Thoracic Surgeons (STS) Score, frailty indices, and major organ system compromise. Efficacy and safety outcomes were compared at baseline, 30 days, and 6 months. ResultsThirty-three patients (mean age 81.9 ± 5.1 years) completed follow-up from May 2021 to March 2022: 18 PR (mean STS Score 15.5 ± 7%) and 15 HR (mean STS Score 6.4 ± 1.7%). The primary efficacy end point of at least 1 grade of TR reduction by 30 days was recorded in 93.9% of all patients, with no device-related adverse events. Improvement in initial New York Heart Association functional class III/IV occurred in 74% of PR and 93% of HR patients. Six-minute walk test increased by 81 ± 43.6 metres (P < 0.001) and 85.8 ± 47.9 metres (P < 0.001), respectively. Renal function tests improved by 15% (P = 0.048) and 7% (P = 0.050), while liver enzymes decreased by 18% (P = 0.020) and 28% (P = 0.052). Right ventricular systolic function increased in both subgroups by at least 24% (P < 0.001). Six-month mortality was 12.1%, with 6 hospitalisations for acute heart failure. ConclusionsTR reduction significantly affected quality of life, functional capacity, cardiac remodelling, and multiorgan involvement similarly in PR and HR patients. TTVR is feasible in very sick symptomatic patients, regardless of predicted risk.

Therapeutic Futility in Nursing: A Focus Group.

Introduction: The implementation of futile nursing interventions seems to be a persistent problem in adult intensive care units. Understanding this phenomenon can contribute to its prevention and all deleterious effects associated with it. Objective: To identify the perceptions of expert nurses from adult intensive care units about therapeutic futility in nursing. Methods: This study consists of a conventional content analysis. Data was collected through a focus group interview that included five expert nurses in adult intensive care, with a minimum of fifteen years of professional experience in intensive care. To analyze the information, the technique of thematic categorical analysis was used, according to Bardin. Results: Four central categories were identified for the topic under study, for which several subcategories were identified that allow a better understanding of this phenomenon. Conclusion: Adult intensive care expert nurses advocate that therapeutic futility in nursing is a reality perceived by teams and families, which should be avoided due to the risk of potentiating the implementation of ethically reprehensible care.

Falla hepática aguda sobre crónica (ACLF), síndrome subdiagnosticado con alta mortalidad

Acute on chronic liver failure is an increasingly recognized syndrome characterized by acute decompensation of chronic liver disease associated with organ failure and high short-term mortality. ACLF is frequent, affecting between 24 and 40% of patients admitted for complications of cirrhosis. Sepsis, active alcoholism, and relapse of chronic viral hepatitis are the most frequent precipitating factors. However, in up to 40%–50% of the cases of ACLF have no identifiable trigger. The stage of severity of Acute on chronic liver failure is very important because it allows us to stratify patients according to their prognosis, evaluate therapeutic response, determine transplant urgency, deciding intensive care unit admission, and also have a basis on which to decide therapeutic futility.

Therapeutic Futility in Terminal Cancer Patients: A Retrospective and Observational Study.

IntroductionAdvanced cancer patients often need therapy for symptomatic control, in addition to cancer and other disease treatments. As the cancer disease progresses and life expectancy decreases, there should be a change in the goal of care. If this change is not accompanied by therapeutic adjustments, there is a risk of maintaining useless and ineffective treatments, as well as potential harmful drug interactions. This study analyzed the prevalence of therapeutic futility in patients with advanced cancer disease.Materials and methodsThis was a retrospective and observational single-center study, that included advanced cancer patients who died during the hospital stay, at a University Hospital in Lisbon, Portugal. Demographic and clinical data were collected. A Palliative Prognostic Score (PaP) was used to stratify patients according to their prognosis group. An analysis of the prescribed therapy was performed to quantify the “potentially inappropriate medications” (PIMs) and “inappropriate medications” (IMs), at admission and 24 hours prior to the patient’s death.ResultsOver 140 patients were included. On the first day of hospitalization, 119 patients (85%) were exposed to at least one IM or PIM and 100 patients (71%) were still exposed to at least one IM or PIM in the last 24 hours of life. Regarding chemotherapy, 66 patients (47%) had treatment in the last two months of life, 38 (27%) in the last month, and 17 (12%) in the last two weeks prior to death.Therapeutic simplification (suspension of IMs and reduction of at least 50% of PIMs during hospitalization) was performed in 43% of the overall population and was higher in PaP score group C, but not statistically significant (p=0.09). The patient's inclusion in PaP score group C and inpatient consultation by the palliative care team were independent predictors of therapeutic simplification.DiscussionThere is an effort to achieve greater therapeutic suitability in palliative patients. However, many patients maintain futile and disproportionate therapy at the end of life (EoL). In many cases, systemic cancer treatment is performed until quite late in the course of the disease. The prescription of PIMs was significantly higher than that of IMs, which could be expected given their definition. A shorter life expectancy at admission led to a greater therapeutic simplification, as well as an intervention by the Palliative Care Team, which can be explained by the more focused approach towards quality-of-life improvement and symptomatic control. Different than expected the prescription of supportive therapies at hospital admission was not a predictor of therapeutic simplification. Although there was a reduction in IMs and PIMs in the studied population, and therapeutic simplification occurred in one fraction of the patients, the fact is that more than half of the patients evaluated did not undergo therapeutic simplification as defined in this work.ConclusionIt appears that there is an effort to achieve greater therapeutic suitability in palliative patients, however, many patients maintain futile therapy at the EoL. It is of paramount importance to change the standard of care in this setting, to privilege a more patient-focused approach and tailored therapy, and to prioritize symptomatic control and quality-of-life improvement.

“Quando ninguém se entende”: conflitos bioéticos num caso real de fim de vida

Introduction: The technical-scientific evolution of the last decades is reflected in the extension of life expectancy, in the reduction of the mortality rate due to infectious diseases and in the increase in mortality due to chronic-degenerative diseases. Added to this is the formation of medical education, increasingly equipped with a model oriented towards the use of highly sophisticated technologies, seeming to neglect the traditional field of the doctor-patient relationship. When the ultimate goal is the cure, death is considered a failure, an unacceptable result. Despite all the effort and technology used, death remains an inevitable outcome. The sick person, when in the background, ceases to be the protagonist of his story. Bioethics is a branch of knowledge that aims to indicate the limits and purposes of man's intervention in life, based on recognition for the dignity of the Human Person. “What should i do against what can I do?” End-of-life care commonly involves ethical issues that lead health professionals, patients and family members to face dilemmas, conflicts. Aim: This paper’s purpose is to show how challenging the decision-making process can be for those involved, namely health professionals, family members and users. Materials and methods: Facing a real case, ethical principles are presented and developed respecting the perspective of bioethics. Results: Starting with the conceptions of dignity, as well as possible weaknesses, covering more technical aspects such as the adequacy of therapeutic effort and proportionality of interventions, contemplating the concepts of obstinacy and therapeutic futility, exploring the dimension of autonomy (including some of its legal aspects) and ending in the field of justice and equity. Having these in hands, it becomes clear the complexity that the decision-making process gains when the humane and multidimensional aspect of the person who suffers, the patient (and family and their loved ones), is called into question. Conclusion: The considerations listed by the bioethical principles help us to base our professional actions, in order to, assist and consider, the environment and principles of the patient, the patient’s family and closed ones along with ours, as an assistance team. Resulting in the neglection of simple and absolute certainties, the lessening of doubts regarding this process and the election of the best possible answer for that specific patient, team and the context that surrounds them. Similarly, on this particular end of life situation, the concept of palliative care is highlighted as a tool of similar impact.

Implantable cardioverter-defibrillator therapy in primary prevention in the elderly

In elderly patients with heart failure and an indication for implantable cardioverter defibrillator (ICD) implantation, the incidence of sudden cardiac death (SCD) increases progressively with age, up to 80-85 years. ICD implantation is a recognized therapy, included in the guidelines for the prevention of SCD in the general population, which is also applied to elderly patients, albeit in an uneven manner, given the lack of robust data in the literature. In fact, the average age of patients included in the main randomized trials on ICDs is about 60 years. All this brings to a series of doubts in this regard, compounded by recent studies that have raised the suspicion of therapeutic futility in the implantation of ICDs in primary prevention in subjects aged ≥70 years, especially in the absence of ischemic heart disease. In the elderly, although the risk of SCD does not vary, the mortality rate for other causes tends progressively to increase with age, as the main consequence of the simultaneous presence of situations such as frailty syndrome and comorbidity. In order to avoid an ageistic attitude, it is therefore necessary to promote randomized controlled trials aimed at a multidimensional evaluation of the elderly patients with an indication for ICD implantation, from which more robust data can be obtained to allow the heart team a selectively targeted evaluation of elderly patients.

1521P Polypharmacy and therapeutic futility in patients near the end of life

The goal for end-of-life cancer patients should be symptom control and improving quality of life through therapeutic optimization and discontinuing futile therapy. However, the maintenance of unneeded drugs is frequent, increasing the risk of harmful drug interactions. The aim of this study was to quantify the number of patients with advanced cancer receiving unnecessary therapies and identify points for improvement in clinical practice. This was a retrospective and observational single-centre study, which included cancer patients that died in the medical oncology unit during a 24 month period. A prognostic score (PaP score) was applied retrospectively. The last chemotherapy (ChT) treatment and drugs prescribed at admission and 24 hours prior to death were analysed and were potentially inappropriate medications (PIMs) were identified. Seventy-four patients were included in the study. On day 1, 89.2% were exposed to at least one PIM, mainly cardiovascular drugs (28.4%), anticoagulants (43.2%), and proton pump inhibitors (74.3%). Twenty-seven patients (36.5%) had a PaP score > 11 (30 day survival probability < 30%). However, there was no significant difference in terms of PIMS in the group with a PaP score > 11 compared to the overall cohort. Therapeutic simplification occurred in 27 patients (36.5%), but PIMs were maintained in 70.3% of patients. Regarding ChT, 34% of patients had ChT in the last two months of life, and 8% in the last two weeks. The prevalence of polypharmacy and PIMs in advanced cancer patients is high. There is a clear need to perform regular prognostic assessments and apply validated prognostic scores to improve clinical practice. Prescriptions must be assessed continuously, aiming to reduce inappropriate drugs, including discontinuation of oncospecific therapy, and favouring symptomatic control and quality of life.

Perceptions of intensive care unit nurses of therapeutic futility: A scoping review

Introduction Intensive care units are contexts in which, due to the remarkable existence of particularly technological resources, interventions are promoted to extend the life of people who experience highly complex health situations. This ability can lead to a culture of death denial where the possibility of implementing futile care and treatment cannot be excluded. Objective To describe nurses’ perceptions of adult intensive care units regarding the therapeutic futility of interventions implemented to persons in critical health conditions. Method Review of the literature following the Scoping Review protocol of the Joanna Briggs Institute. The Population, Concept, and Context mnemonic was used to elaborate the research question and the research was performed using the EBSCOHost search engine in the CINAHL Complete databases, MEDLINE Complete, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews to identify studies published between 1990 and 2019. Seven studies were selected. Results Nurses consider that therapeutic futility, a current problem in adult intensive care units, may have a negative impact on persons in critical health conditions and that contributes directly to resource expenditure and moral conflicts and consequently leads to emotional exhaustion. Conclusion Due to the complexity of this concept, knowing and understanding people’s and families’ perceptions is crucial to the decision-making process, for which reason nurses can play a key role in managing these situations.

Common medical ethical issues faced by healthcare professionals in KSA.

ObjectiveThere are growing concerns about ethical issues in the healthcare system. This study was conducted to determine the nature of common ethical issues faced by healthcare providers in a tertiary-care hospital in KSA.MethodThis cross-sectional study comprised a self-administered questionnaire given to the physicians working at King Abdulaziz Medical City Hospital-Riyadh, Ministry of National Guard Health Affairs (KAMC-RD, MNGHA). We used a convenience sampling technique during symposia and conferences.ResultsWe distributed 240 questionnaires amongst the physicians and recorded a response rate of 80%; 68% (136) of the respondents were men, while 82.5% were Saudis. The mean age of the group was 34.08 ± 10.43 years. Only 69% (138) of the physicians had ever received any formal teaching in bioethics. Most physicians (77.5%) demanded clear guidelines to help them to take appropriate ethical decisions on therapeutic futility, whereas 54% felt that they sometimes overtreat their patients.ConclusionThis study reported a lack of knowledge in certain healthcare-related ethical issues in a significant proportion of the physicians. There is a need for a standard educational agenda for medical ethics for healthcare providers, not only during medical school but also after graduation and during clinical rounds.

A reflection on therapeutic futility: in Portuguese primary care context

A reflection on therapeutic futility: in Portuguese primary care context

Results After Implementing a Program of Intensive Care to Facilitate Organ Donation

A program of intensive care to facilitate organ donation (ICOD) represents one of the ways to increase donation rate following brain death (BD). ObjectivesTo analyze the impact and cost-effectiveness of setting up an ICOD strategy. MethodRetrospective cases of BD donors from the Spanish region La Rioja were included, after implementation of an ICOD program (2011–2016). This was activated in cases of devastating neurologic injury where treatment had been rejected following therapeutic futility criteria. Follow-up of kidney and liver transplant patients with the obtained grafts was carried out. ResultsA total of 134 potential donors were admitted to intensive care unit (ICU), of whom 106 were selected under the ICOD strategy. BD was diagnosed in 108 cases (25 conventional donors, 83 ICOD donors). A total of 21.6% of potential ICOD donors did not evolve to BD, subsequently dying in the ICU. ICOD cases accounted for more than 50% of donors each year. This cohort had an average stay of 2.4 days in the ICU and accounted for a small proportion of total ICU admissions. A total of 68 (81.9%) ICOD donors were finally effective and 146 grafts were extracted, the majority being abdominal organs (liver and kidney). Probability of survival 1 year after liver transplant (ICOD donor) was 90.9%, with 1 case of primary graft failure. Survival 1 year after kidney transplant (ICOD donor) was 92.7%. No differences were detected in survival rates of kidney and liver transplant patients regarding donor type (ICOD vs conventional). ConclusionsImplementation of an ICOD program allows an increase in the pool of valid and quality grafts for transplant as well as implying a minimum consumption of intensive medicine resources. The results in transplant patients support this strategy.