If a patient requests aggressive treatment that may be futile, what is the appropriate nursing approach?

• A. Provide balanced information, discuss goals, involve ethics, and align decisions with patient goals.
• B. Agree to the request to avoid conflict.
• C. Refuse to discuss outcomes and end conversation.
• D. Initiate withdrawal of care without consent.

Answer: (C)

When a patient requests aggressive treatment that may be futile, the nursing approach rests on open, balanced communication that helps clarify prognosis, options, and goals of care, and then aligns plans with the patient’s values and preferences. Start by providing clear information about what the treatment can realistically achieve, its burdens, and the likelihood of benefit, so the patient understands the trade-offs. Then explore the patient’s goals: what outcome do they hope to achieve, what quality of life matters to them, and what trade-offs are acceptable? This prevents pursuing nonbeneficial care simply to avoid conflict and honors the patient’s autonomy.

Involve the rest of the care team, and consider a referral to ethics or palliative care when there’s uncertainty or disagreement. Document the goals of care, and work toward decisions that reflect the patient’s informed choices, updating as the situation evolves. If the patient lacks decision-making capacity, involve a legally authorized surrogate and any advance directives to guide care.

Choosing to agree to the request just to avoid conflict overlooks the patient’s autonomy and the physician-nurse responsibilities to provide truthful information and guidance. Refusing to discuss outcomes and ending the conversation halts informed decision-making and can erode trust. Initiating withdrawal of care without consent violates ethical and legal standards.