Causes of futile life-sustaining interventions from the perspective of physicians and nurses in university hospitals in Tehran

Background Providing futile interventions can lead to moral distress for healthcare providers and impose high costs on healthcare systems. Despite this, evidence demonstrates that such interventions still continue in many parts of the world, particularly in Low and Middle Income Countries (LMICs). Therefore, this current study was conducted to investigate reasons for providing futile interventions from the perspective of physicians and nurses working at hospitals affiliated to Tehran University of Medical Sciences (TUMS) Method In this cross-sectional (descriptive-analytical) study, 249 participants including 128 physicians and 121 nurses working in hospitals affiliated to TUMS were recruited through convenience sampling. Data was collected using a 25-item questionnaire assessing causes of providing futile medical and life-sustaining interventions, grouped into 3 domains of “demands of patients/relatives”, “personal reasons of the healthcare team” and “organisation/infrastructural” limitations. Data was analysed using SPSS 16 and the extent to which participants agreed with each of the causes of futile interventions was expressed as a percentage. Comparisons between the views of physicians and nurses on individual questionnaire items was performed using the Chi-squared test. A linear regression analysis was used to compare the views of physicians and nurses in each of the 3 domains of the questionnaire, and for intra-group comparisons. Results For both physicians and nurses, the most common reasons for futile interventions related to patients and their relatives including demands/insistence on the continuation of treatment and false hope for the patient’s recovery. Compared to physicians, nurses gave greater importance to the domains of patient/relatives’ demands as well as personal reasons of the healthcare team. Physicians expressed strongest agreement with the domain of organisation/infrastructural limitations, including lack of guidelines and palliative care centres. Conclusion This study demonstrates that despite awareness of the healthcare team members regarding the futility of some interventions, they are still performed due to the reasons highlighted. Therefore, it clinical guidelines should be developed for appropriate end-of-life care, including restricting the use of futile interventions, increase public and professional awareness and knowledge around futile end-of-life interventions and strengthen palliative care services, thereby leading to greater efficiency and justice in the healthcare system.