Date of Award

January 2014

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Margaret A. Drickamer

Subject Area(s)

Medicine

Abstract

This qualitative study was conducted to more fully elucidate the breadth of variables leading to the provision of medically futile care, and in doing so allow for the development of more comprehensive solutions to address this challenge in clinical practice. Semi-structured interviews were conducted. Interview transcripts were coded by several members of a multidisciplinary team and analyzed with the help of NVivo software. Inductive and deductive techniques were used in an iterative process of data analysis, ultimately leading to the proposed taxonomy that describes the antecedents to medical futility. The work groups factors contributing to the provision of medically futile care into one of two general categories: external and internal. Among the variables external to the clinician, three sub-categories were identified: (1) People/Relationships, (2) System of Care Delivery, and (3) Cultural/Sociological Stressors. Similarly, the variables internal to the clinician were grouped into three sub-categories: (1) Emotions, (2) Dimensions of the Individual, and (3) Frame of Reference. Ultimately, this study overcomes the limitations on the descriptive capacity of quantitative research, to offer a better understanding of the complexity of factors leading to the provision of medically futile care. Clinicians respond to an array of external and internal cues when offering and delivering care they themselves describe as futile. Incomplete understandings of this phenomenon have led to marginal success in addressing the sequelae of futile care.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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