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Table 2 Matrix of defining non-beneficial and related inappropriate treatment at end-of-life based on relevant review literaturea

From: A systematic review defining non-beneficial and inappropriate end-of-life treatment in patients with non-cancer diagnoses: theoretical development for multi-stakeholder intervention design in acute care settings

 

Patients and family/guardians’ perspectives

Healthcare practitioners’ perspectives

Alignment to Clinical Benefit or with Agreed Treatment Goals

Non-beneficial treatment

• Attempts at curative or life-prolonging treatments that are not consistent with the agreed goals of care, i.e., especially when these are continued though unlikely to succeed, and/or considered by patient, family/guardians to result in unacceptable quality of life1−19 (n = 19)

• Burden likely to outweigh the clinical benefits of treatment2−4, 9−11, 14−15, 18−42 (n = 32), i.e., would fail to achieve positive results such as recovery, symptom relief, or quality of life improvement

• When curative treatment is no longer an option but continues or is escalated leading to excessive or aggressive care (n = 9) 14, 17, 18, 22, 24, 25, 43−45 inhibiting a peaceful death or prolonging the suffering of dying24, 44, 46, 47−49 (n = 6)

Inappropriate treatment at end-of-life

• Treatment that are counter to the patient’s or family/guardians’ wishes can be deemed inappropriate5, 18, 19 (n = 3)

• It can be deemed inappropriate to extend considerable resources when these are judged likely to exceed the clinical benefits or reasonable hope2, 31, 36, 40, 48 (n = 5)

  1. aPlease see Supplementary File 2 for reference list as ordered in Table citations