An Evolutionary Concept Analysis Of Futility In Health Care

Keywords

communication; concept analysis; ethics; nurse–patient relationships; patient advocacy; quality of life

Abstract

Aim: To report a concept analysis of futility in health care. Background: Each member of the healthcare team: the physician, the nurse, the patient, the family and all others involved perceive futility differently. The current evidence and knowledge in regard to futility in health care manifest a plethora of definitions, meanings and interpretations without consensus. Design: Concept analysis. Data Sources: Databases searched included Medline, Cumulative Index of Nursing and Allied Health Literature, Academic Search Premier, Cochrane Database of Systematic Reviews and PsycINFO. Search terms included “futil*,” “concept analysis,” “concept,” “inefficacious,” “non-beneficial,” “ineffective” and “fruitless” from 1935–2016 to ensure a historical perspective of the concept. A total of 106 articles were retained to develop the concept. Methods: Rogers’ evolutionary concept analysis was used to evaluate the concept of futility from ancient medicine to the present. Results: Seven antecedents (the patient/family autonomy, surrogate decision-making movement, the patient–family/physician relationship, physician authority, legislation and court rulings, catastrophic events and advancing medical technology) lead to four major attributes (quantitative, physiologic, qualitative, and disease-specific). Ultimately, futile care could lead to consequences such as litigation, advancing technology, increasing healthcare costs, rationing, moral distress and ethical dilemmas. Conclusion: Futility in health care demonstrates components of a cyclical process and a consensus definition is proposed. A framework is developed to clarify the concept and articulate relationships among attributes, antecedents and consequences. Further testing of the proposed definition and framework are needed.

Publication Date

6-1-2018

Publication Title

Journal of Advanced Nursing

Volume

74

Issue

6

Number of Pages

1289-1300

Document Type

Article

Personal Identifier

scopus

DOI Link

https://doi.org/10.1111/jan.13526

Socpus ID

85041863351 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/85041863351

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