Palliative and Supportive Care

Original Articles

Do residents need end-of-life care training?

Agata Marszalek Litauskaa1, Andrzej Kozikowskia1, Christian N. Nouryana1, Myriam Klinea1a2, Renee Pekmezarisa1a2a3a4 c1 and Gisele Wolf-Kleina1a3a4

a1 North Shore-LIJ Health System, Great Neck, New York

a2 Feinstein Institute for Medical Research, Manhasset, New York

a3 Hofstra North Shore-LIJ School of Medicine, Hempstead, New York

a4 Albert Einstein College of Medicine, Bronx, New York


Objective: As medical education evolves, emphasis on chronic care management within the medical curriculum becomes essential. Because of the consistent lack of appropriate end-of-life care training, far too many patients die without the benefits of hospice care. This study explores the association between physician knowledge, training status, and level of comfort with hospice care referral of terminally ill patients.

Method: In 2011, anonymous surveys were distributed to physicians in postgraduate years 1, 2, and 3; fellows; hospital attending physicians; specialists; and other healthcare professionals in five hospitals of a large health system in New York. Demographic comparisons were performed using χ2 and Fisher's exact tests. Spearman correlations were calculated to determine if professional status and experience were associated with comfort and knowledge discussing end-of-life topics with terminal patients.

Results: The sample consisted of 280 participants (46.7% response rate). Almost a quarter (22%) did not know key hospice referral criteria. Although 88% of respondents felt that knowledge of hospice care is an important competence, 53.2% still relinquished advance directives discussion to emergency room (ER) physicians. Fear of patient/family anger was the most frequently reported hospice referral barrier, although 96% of physicians rarely experienced reprisals. Physician comfort level discussing end-of-life issues and hospice referral was significantly associated with the number of years practicing medicine and professional status.

Significance of results: Physicians continue to relinquish end-of-life care to ER staff and palliative care consultants. Exploring unfounded and preconceived fears associated with hospice referral needs to be integrated into the curriculum, to prepare future generations of physicians. Medical education should focus on delivering the right amount of end-of-life care training, at the right time, within the medical school and residency curriculum.

(Received August 10 2012)

(Accepted August 27 2012)


  • End-of-life care;
  • Hospice;
  • Training;
  • Barriers to hospice referral


c1 Address correspondence and reprint requests to: Renee Pekmezaris, North Shore-LIJ Health System, 175 Community Dr., Great Neck, NY 11021. E-mail: