Developing a Tool for Evaluation of Causes of Futile Care in Intensive Care Units

Leili Yekefallah, Tahereh Ashktorab, Houman Manoochehri, Hamid Alavi Majd


Background: In Iran, futile care has become a challenge for intensive care nurses. The aim of the study was to develop a tool for assessing the reasons of futile care at intensive care units (ICUs).   

Materials and Methods: A sequential mixed method in three stages was applied. In the first stage, a phenomenological study was performed with van Manen’s method by interviewing 25 nurses at ICUs of 11 hospitals in Qazvin. To extract the items of the tool in the second stage, the concept of futile care in ICUs and its reasons were defined. Ultimately, the psychometric properties of the questionnaire were evaluated with face validity, content validity (quantitative and qualitative), construct validity (exploratory factor analysis), internal consistency (Cronbach’s alpha), and test–retest reliability.  

Results: The initial tool had 119 questions. After validation, 39 items remained in the final questionnaire. Five extracted factors were as follows: professional competence (14 items), organizational policy (9 items), socio‑cultural factors (7 items), personal beliefs and values (4 items), and legal issues (5 items). Cronbach’s alpha for the whole questionnaire was 0.91 (range: 0.71–0.96). The test–retest reliability was 0.87 (p < 0.001).   

Conclusions: Nursing managers and clinical nurses can use this tool to identify the causes of futile care and reduce it in their clinical settings. Policy makers can use this tool for improving the management of ICUs.  



Intensive care unit, medical futility, nurses, psychometric

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Gabbay E, Calvo‑Broce J, Meyer KB, Trikalinos TA, Cohen J, Kent DM, et al. The empirical basis for determinations of medical futility. J Gen Intern Med 2010;25:1083‑9.

Palda VA, Bowman KW, McLean RF, Chapman MG. “Futile” care: Do we provide it? Why? A semistructured, Canada‑wide survey of intensive care unit doctors and nurses. J Crit Care 2005;20:207‑13.

Heland M. Fruitful or futile: Intensive care nurses’ experiences and perceptions of medical futility. Aust Crit Care 2006;19:25‑31.

Chwang E. Futility clarified. J Law Med Ethics 2009;37:487‑95, 396.

Niederman MS, Berger JT. The delivery of futile care is harmful to other patients. Crit Care Med 2010;38:S518‑22.

Neuberg GW. The cost of end‑of‑life care: A new efficiency measure falls short of AHA/ACC standards. Circ Cardiovasc Qual Outcomes 2009;2:127‑33.

Sibbald R, Downar J, Hawryluck L. Perceptions of “futile care” among caregivers in intensive care units. CMAJ 2007;177:1201‑8.

Yekefallah L, Ashktorab T, Manoochehri H, Alavi majd H. Nurses’ experiences of futile care at intensive care units: A phenomenological study. Global Journal of Health Science. 2015;7:235‑42.

Van Manen, M. Phenomenology of Practice. New York: Routledge; 2014.

Polit DF, Beck CT. Nursing Research: Generating and Assessing Evidence for nursing practice. 8th ed. Wolters Kluwer Health, Lippincott, Williams and Wilkins; 2008. p. 519‑21.

Andrew SH, Halcomb EJ. Mixed Methods Research for Nursing and the Health Sciences. United Kingdom: Wiley‑Blackwell Publisher; 2009.

Munro BH. Statistical Methods for Health Care Research. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

Wilson F, Robert PW, Schumsky DA. Recalculation of the critical values for Lawshe’s content validity ratio. Meas Eval Couns Dev 2012;45:197‑210.

Creswell JW, Clark P. Designing and Conducting Mixed Methods Research. Thousand Oaks, CA: Sage Publications, Inc.; 2011.

Lobindo‑Wood G, Haber J. Nursing Research: Methods and Critical Appraisal for Evidence‑Based Practice. 7th ed. St. Louis: Mosby Co.; 2006.

Tashakkori A, Teddlie CH. Putting the human back in “Human Research Methodology”: The researcher in mixed methods research. J Mix Methods Res 2010;4:271‑7.

Burns N, Grove SK. Understanding Nursing Research. 4th ed. St. Louis: W.B. Sunders Co.; 2006.

Hansen L, Goodell TT, Dehaven J, Smith M. Nurses’ perceptions of end‑of‑life care after multiple interventions for improvement. Am J Crit Care 2009;18:263‑71.

Jensen HI, Ammentorp J, Erlandsen M, Ording H. End‑of‑life practices in Danish ICUs: Development and validation of a questionnaire. BMC Anesthesiol 2012;12:16.


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