Hostname: page-component-7c8c6479df-ph5wq Total loading time: 0 Render date: 2024-03-29T05:27:42.926Z Has data issue: false hasContentIssue false

Do residents need end-of-life care training?

Published online by Cambridge University Press:  14 May 2013

Agata Marszalek Litauska
Affiliation:
North Shore-LIJ Health System, Great Neck, New York
Andrzej Kozikowski
Affiliation:
North Shore-LIJ Health System, Great Neck, New York
Christian N. Nouryan
Affiliation:
North Shore-LIJ Health System, Great Neck, New York
Myriam Kline
Affiliation:
North Shore-LIJ Health System, Great Neck, New York Feinstein Institute for Medical Research, Manhasset, New York
Renee Pekmezaris*
Affiliation:
North Shore-LIJ Health System, Great Neck, New York Feinstein Institute for Medical Research, Manhasset, New York Hofstra North Shore-LIJ School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
Gisele Wolf-Klein
Affiliation:
North Shore-LIJ Health System, Great Neck, New York Hofstra North Shore-LIJ School of Medicine, Hempstead, New York Albert Einstein College of Medicine, Bronx, New York
*
Address correspondence and reprint requests to: Renee Pekmezaris, North Shore-LIJ Health System, 175 Community Dr., Great Neck, NY 11021. E-mail: rpekmeza@nshs.edu

Abstract

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Accreditation Council for Graduate Medical Education (ACGME). Internal Medicine Residency Programs FAQ. Retrieved from http://www.acgme.org/acWebsite/RRC_140/140_FAQ.pdf.Google Scholar
Angus, D.C., Barnato, A.E., Linde-Zwirble, W.T., et al. (2004). Use of intensive care at the end of life in the United States: An epidemiologic study. Critical Care Medicine, 32, 638643.CrossRefGoogle ScholarPubMed
Aulino, F. & Foley, K. (2001). Professional education in end-of-life care: A US perspective. Journal of the Royal Society of Medicine, 94, 472476.Google Scholar
Back, A.L., Arnold, R.M., Baile, W.F., et al. (2007). Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Archives of Internal Medicine, 167, 453.Google Scholar
Billings, M.E., Engelberg, R., Curtis, J.R., et al. (2010). Determinants of medical students' perceived preparation to perform end-of-life care, quality of end-of-life care education, and attitudes toward end-of-life care. Journal of Palliative Medicine, 13, 319326.CrossRefGoogle ScholarPubMed
Boyd, D., Merkh, K., Rutledge, D.N., et al. (2011). Nurses' perceptions and experiences with end-of-life communication and care. Oncology Nursing Forum, 38, E229E239.Google Scholar
Brickner, L., Scannell, K., Marquet, S., et al. (2004). Barriers to hospice care and referrals: Survey of physicians' knowledge, attitudes, and perceptions in a health maintenance organization. Journal of Palliative Medicine, 7, 411418.Google Scholar
Bui, T. (2012). Effectively training the hospice and palliative medicine physician workforce for Improved end-of-life health care in the United States. American Journal of Hospice and Palliative Medicine29, 417420.Google Scholar
Christakis, N.A. (1995). The similarity and frequency of proposals to reform US medical education. The Journal of the American Medical Association, 274, 706711.CrossRefGoogle ScholarPubMed
Dooley-Hash, S. (2010). Educating physicians: A call for reform of medical school and residency. The Journal of the American Medical Association, 304, 12401241.Google Scholar
Feeg, V.D. & Elebiary, H. (2005). Exploratory study on end-of-life issues: Barriers to palliative care and advance directives. American Journal of Hospice and Palliative Medicine, 22, 119124.CrossRefGoogle Scholar
Fineberg, I.C., Wenger, N.S. & Forrow, L. (2004). Interdisciplinary education: evaluation of a palliative care training intervention for pre-professionals. Journal of the Association of American Medical Colleges, 79, 769776.Google Scholar
Gisondi, M.A. (2009). A case for education in palliative and end-of-life care in emergency medicine. Academic Emergency Medicine, 16, 181183.Google Scholar
Goldsmith, J., Wittenberg-Lyles, E., Shaunfield, S., et al. (2011). Palliative care communication curriculum: What can students learn from an unfolding case? American Journal of Hospice and Palliative Medicine, 28, 236241.CrossRefGoogle ScholarPubMed
Himmelstein, D.U., Thorne, D., Warren, E., et al. (2009). Medical bankruptcy in the United States, 2007: Results of a national study. American Journal of Medicine, 122, 741746.Google Scholar
Hirsh, D., Gaufberg, E., Ogur, B., et al. (2012). Educational outcomes of the Harvard Medical School–Cambridge integrated clerkship: A way forward for medical education. Academic Medicine, 87, 643.CrossRefGoogle ScholarPubMed
Irby, D.M., Cooke, M. & O'Brien, B.C. (2010). Calls for reform of medical education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010. Academic Medicine, 85, 220227.CrossRefGoogle ScholarPubMed
Jacoby, L.H., Beehler, C.J. & Balint, J.A. (2011). The impact of a clinical rotation in hospice: Medical students' perspectives. Journal of Palliative Medicine, 14, 5964.CrossRefGoogle ScholarPubMed
Liao, S., Amin, A. & Rucker, L. (2004). An innovative, longitudinal program to teach residents about end-of-life care. Academic Medicine, 79, 752757.Google Scholar
Lind, R., Lorem, G., Nortvedt, P., et al. (2011). Family members' experiences of “wait and see” as a communication strategy in end-of-life decisions. Intensive Care Medicine, 37, 11431150.CrossRefGoogle ScholarPubMed
Meo, N., Hwang, U. & Morrison, R.S. (2011). Resident perceptions of palliative care training in the emergency department. Journal of Palliative Medicine, 14, 548555.CrossRefGoogle ScholarPubMed
Morrison, R.S., Morrison, E.W. & Glickman, D.F. (1994). Physician reluctance to discuss advance directives: An empiric investigation of potential barriers. Archives of Internal Medicine, 154, 23112318.CrossRefGoogle ScholarPubMed
Mularski, R.A., Heine, C.E., Osborne, M.L., et al. (2005). Quality of dying in the ICU: Ratings by family members. Chest, 128, 280287.CrossRefGoogle ScholarPubMed
National Hospice and Palliative Care Organization (NHPCO) Facts and Figures: Hospice Care in America. Retrieved from http://www.nhpco.org/files/public/Statistics_Research/2011_Facts_Figures.pdf.Google Scholar
Ogle, K.S., Mavis, B. & Wyatt, G.K. (2002). Physicians and hospice care: Attitudes, knowledge, and referrals. Journal of Palliative Medicine, 5, 8592.CrossRefGoogle ScholarPubMed
Pekmezaris, R., Walia, R., Nouryan, C., et al. (2011). The impact of an end-of-life communication skills intervention on physicians-in-training. Gerontology & Geriatrics Education, 32, 152163.CrossRefGoogle ScholarPubMed
Pfeifer, M.P., Mitchell, C.K. & Chamberlain, L. (2003). The value of disease severity in predicting patient readiness to address end-of-life issues. Archives of Internal Medicine, 163, 609612.Google Scholar
Quest, T.E., Asplin, B.R., Cairns, C.B., et al. (2011). Research priorities for palliative and end-of-life care in the emergency setting. Academic Emergency Medicine, 18, e70e76.Google Scholar
Quill, T.E. (2000). Initiating end-of-life discussions with seriously ill patients. The Journal of The American Medical Association, 284, 25022507.CrossRefGoogle ScholarPubMed
Reinke, L.F., Slatore, C.G., Uman, J., et al. (2011). Patient–clinician communication about end-of-life care topics: Is anyone talking to patients with chronic obstructive pulmonary disease? Journal of Palliative Medicine, 14, 923928.CrossRefGoogle ScholarPubMed
Sanchez-Reilly, S. & Ross, J.S. (2012). Hospice and palliative medicine: Curriculum evaluation and learner assessment in medical education. Journal of Palliative Medicine, 15, 116122.CrossRefGoogle ScholarPubMed
Sullivan, A.M., Lakoma, M.D., Billings, J.A., et al. (2005). Teaching and learning end-of-life care: Evaluation of a faculty development program in palliative care. Journal of the Association of American Medical Colleges, 80, 657668.Google Scholar
Teno, J.M., Casarett, D., Spence, C., et al. (2012). It is “too late” or is it? Bereaved family member perceptions of hospice referral when their family member was on hospice for seven days or less. Journal of Pain and Symptom Management, 43, 732738.Google Scholar
Whitcomb, M.E. (2005). Redesigning clinical education: A major challenge for academic health centers. Academic Medicine, 80, 615616.Google Scholar