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Clinical indicators of treatment futility and imminent terminal decline as discussed by multidisciplinary teams in long-term care

College of Nursing and Health Science, George Mason University, Fairfax, Virginia

Sharon Moore, MSW, LCSW

Hospice Alternative Residence Teams (HART), Hospice at Charlotte, North Carolina

Pamala D. Larsen, PhD, RN, CRRN

College of Health and Human Services, School of Nursing, University of North Carolina, Charlotte, North Carolina

Michael Turner, PhD

Department of Kinesiology, College of Health and Human Services, University of North Carolina, Charlotte, North Carolina

Focus group methodology was used to describe how members of multidisciplinary teams in long-term care facilities recognize when residents are approaching end-stage disease, document evidence that associated treatment futility has occurred, and convey this information to the residents, each other, and family members. In addition to the typical clinical indicators of treatment futility found in the literature (e.g., recurrent infections, weight loss, falls, functional decline), team members described a set of physical and affective changes that were apparent to them as their residents approached trajectories of imminent terminal decline. While more difficult to quantify and measure, these other indicators have a significant impact on the ways that team members assess and interpret a person’s survival potential. Using these indicators of both treatment failure and imminent decline requires knowledge of a resident’s history, clinical condition, course of care, and individual idiosyncrasies. Together, the indicators offer important cues that are needed for the identification of persons who might benefit from earlier transitions to palliative care.

Key Words: late-life long-term care • palliative care • transitions in care

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