Those tools, he adds, "ventilators, dialysis and ECMO [extracorporeal membrane oxygenation] machines, drugs and left ventricular assist devices, things that beat instead of the heart—they work for some people, but not others, and it's when they've done their best to make patients better but they're not better, that these doctors are saying we shouldn't do this anymore; we should be converting to palliative care."
For the most part, these ICU patients "didn't have the capacity to appreciate the care they were receiving," Wenger says. "Some were in a persistent vegetative state, with severe cognitive impairment, or fed through a tube and couldn't interact."
"It does leave you with the question [of] why (these critical care specialists) are continuing to provide this treatment if they're calling it futile."
Sometimes, "families don't want to hear it and don't want to pull back, and doctors feel caught in between. And maybe doctors aren't having conversations quite well enough so families truly understand in a timely enough fashion. In some cases, these patients were very ill before they came to the ICU, but there hadn't been adequate conversations directly with these patients about the goals of their care," Wegner says.
Researchers, he adds, think the problem lies in lack of communication, among and between doctors caring for the patients and between caregivers and families.