Explaining the Process of Determining Futility Increases Lay Public Acceptance.

RATIONALE: National guidelines have laid out a process to conflict resolution in cases of potentially inappropriate medical interventions.

OBJECTIVE: To determine the effect of information about a process-based approach on lay public perceptions of the appropriateness of withholding medically inappropriate interventions.

METHODS: Respondents from a nationwide sample completed a survey with two adult ICU-based vignettes: one about advanced cancer where doctors told the family that additional chemotherapy would not be offered, and a second case of multi-organ failure after brain hemorrhage where dialysis would not be offered. Participants were randomly assigned to see or not see information about a detailed process for the determination to withhold (second opinion, ethics consultation, exploring transfer to another institution). The primary outcome was the appropriateness of not providing the treatment (4-point scale, dichotomized for analysis), and the secondary outcome was the negative emotional reaction to the case (Positive and Negative Affect Schedule).

RESULTS: A total of 1225 respondents were included. Providing detailed process information increased the perceived appropriateness of withholding treatment by approximately 10 percentage points in each vignette: (chemotherapy: 76.3% to 85.6%; dialysis: 68.6% to 79.2%). Process information remained associated with appropriateness of withholding treatment after adjustment for order and respondent characteristics (chemotherapy; OR 2.04, 95% CI 1.47, 2.83; dialysis OR 1.90, 95%CI 1.43, 2.54). Process information had no effect on the emotional response to the cases.

CONCLUSION: Providing process-based conflict resolution information increases public acceptance of determinations of medical futility, supporting the practice outlined in national consensus statements.