To compare the perception of provision of futile care in the Neurointensive Care Unit (NSICU) among  physicians (MD), advance practice providers (APPs) and critical care registered nurses (CCRN)

Prospective study performed at an academic NSICU.  A  data collection form was used to ask the MD, APP, and CCRN if they perceived that they were providing futile care to NSICU patients . Clinicians were asked if they considered the treatment to be acceptable for a loved one. Demographics, diagnosis and reason for futility perception were collected. Fishers exact test, it's Freeman-Halton extension, and Krukal- Wallis test were used to compare results. Futility was analyzed independently and in an aggregate manner (yes/probable combined, and no/probable combined).  Age was analyzed continuously and in decade intervals. Pre-determined sample size was 77.

77 patients with a median age of 60.89 were analyzed (53% males and 68% Caucasian). Responses were 77 (33%) futile, 136 (59%) non-futile, and 18(8%) probable. MDs and NPs deemed care futile in 36% of patients, CCRNs in 27% (p<0.05 ). Affirmative response to treatment acceptable for a loved one was seen in 41/77 (53%) MDs, 33/77 (43%) APPs, and 37/77 (48%) CCRNs (p<0.05). Age, race, or diagnosis did not influence response. Percent agreement for futility perception averaged 71% ( K 0.46) while for wanting treatment for loved one averaged 78%(  K 0.568). MDs and APPs agreed more on futility provision; APPs and CCRNs on provision of care for a loved one.

Clinicians in the NSICU perceive that they are providing futile care in one third of patients but with moderate correlation. No specific clinical factor appears to be associated with such perception.