Clinicians' Perceptions of Futile or Potentially Inappropriate Care and Associations with Avoidant Behaviors and Burnout

Abstract

<b><i>Background:</i></b> Futile or potentially inappropriate care (futile/PIC) for dying inpatients leads to negative outcomes for patients and clinicians. In the setting of rising end-of-life health care costs and increasing physician burnout, it is important to understand the causes of futile/PIC, how it impacts on care and relates to burnout. <b><i>Objectives:</i></b> Examine causes of futile/PIC, determine whether clinicians report compensatory or avoidant behaviors as a result of such care and assess whether these behaviors are associated with burnout. <b><i>Design:</i></b> Online, cross-sectional questionnaire. <b><i>Setting/Subjects:</i></b> Clinicians at two academic hospitals in New York City. <b><i>Methods:</i></b> Respondents were asked the frequency with which they observed or provided futile/PIC and whether they demonstrated compensatory or avoidant behaviors as a result. A validated screen was used to assess burnout. <b><i>Measurements:</i></b> Descriptive statistics, odds ratios, linear regressions. <b><i>Results:</i></b> Surveys were completed by 349 subjects. A majority of clinicians (91.3%) felt they had provided or "possibly" provided futile/PIC in the past six months. The most frequent reason cited for PIC (61.0%) was the insistence of the patient's family. Both witnessing and providing PIC were statistically significantly (<i>p</i> < 0.05) associated with compensatory and avoidant behaviors, but more strongly associated with avoidant behaviors. Provision of PIC increased the likelihood of avoiding the patient's loved ones by a factor of 2.40 (1.82-3.19), avoiding the patient by a factor of 1.83 (1.32-2.55), and avoiding colleagues by a factor of 2.56 (1.57-4.20) (all <i>p</i> < 0.001). Avoiding the patient's loved ones (<i>β</i> = 0.55, SE = 0.12, <i>p</i> < 0.001), avoiding the patient (<i>β</i> = 0.38, SE = 0.17; <i>p</i> = 0.03), and avoiding colleagues (<i>β</i> = 0.78, SE = 0.28; <i>p</i> = 0.01) were significantly associated with burnout. <b><i>Conclusions:</i></b> Futile/PIC, provided or observed, is associated with avoidance of patients, families, and colleagues and those behaviors are associated with burnout.