Many doctors are continuing to provide end-of-life patients with needless treatments that only worsen the quality of their last days, new research shows.
Our review published in the International Journal for Quality in Health Care found that on average, one-third of patients near the end of their life received non-beneficial treatments in hospitals around the world.
Non-beneficial treatments are those unlikely to ensure survival beyond a few days that can also impair the quality of remaining life. They include putting a patient on a ventilator to help their breathing, tube-feeding, emergency surgical procedures, CPR on patients with not-for-resuscitation orders and blood transfusions or dialysis in the last few days of life.
Initiating chemotherapy or continuing radiotherapy in the last few weeks of life for patients with advanced irreversible disease was also common. Chemotherapy was initiated in 33% of cases and radiotherapy continuation in 7%.
We reviewed 38 studies conducted over the past two decades, covering 1.2 million patients, bereaved relatives, doctors and nurses in ten countries. We also found evidence of unnecessary imaging such as X-rays (25-37%) and blood tests (49%).
Many patients were treated for a number of other underlying conditions with oral or intravenous medicines that made little or no difference to their survival and were inconvenient and in some cases, harmful.
Non-beneficial treatments
Advances in medical technology have fuelled unrealistic expectations of the healing power of doctors and the tools at their disposal. This is particularly the case in the treatment of the elderly.
Research shows some families pressure doctors to attempt heroic interventions on elderly relatives. This is often because families don’t know their loved one’s wishes as the patient’s prognosis or limitations of treatment haven’t been discussed with them by the doctor.
Doctors struggle with the ethical ambivalence of delivering what they were trained to do – save lives – and the patient’s right to die with dignity.
According to clinicians, family requests to continue treating their elderly relative at the end of their life – due to poor acceptance of prognosis, cultural beliefs and disagreement with medical decisions – are the main reason for provision of non-beneficial treatment.
But doctors have also argued they deliver non-beneficial care because they fear being mistaken on their estimation of patients’ time to death.