2001. Residents' Attitudes
toward End of Life Care
SP Fein, Greater Los Angeles Healthcare System, SE Sherman, Greater Los Angeles Healthcare System, LA Mankin, Greater Los Angeles Healthcare System
attitudes develop during residency training when direct patient care begins, yet
few studies have examined U.S. internal medicine residents’ attitudes toward
end of life care issues.
Methods: A 2-page survey
with 17 short vignettes designed to determine resident’s attitudes and
behaviors regarding the care of dying patients, autonomy, futility, physician
assisted suicide (PAS), indirect euthanasia, and active and passive euthanasia
was administered in May and June 2001 to internal medicine residents at three
sites, including Sepulveda VA (n=104), West Los Angeles VA (n=45) and UCLA
(n=27). Six statements established the respondent’s comfort with dealing with
a dying patient and were scored on a 5-point scale with 1 representing
“strongly agree” and 5 representing “strongly disagree”. The next 11
vignettes were similarly scored. Independent
t tests and regression models were used to analyze the data.
Results: The response
rate was 93% (176/189). Forty
percent of respondents were women and 53% were new interns (surveyed during
orientation). Most residents answered similarly endorsing indirect euthanasia
(mean=1.46). Less experienced residents were more reluctant than their
experienced counterparts regarding the vignettes representing patient autonomy
(2.20 vs. 1.74, p<.003), medical futility (4.48 vs. 3.08, p<.001), comfort
with a dying patient (3.29 vs. 2.79, p<.003) and behaviors with respect to
PAS (2.98 vs. 2.46, p<.008) and active euthanasia (3.23 vs. 2.73, p<.004).
Residents who reported having formal training in end of life care were more
comfortable with a dying patient (2.66 vs. 3.22, p < .001) and reported more
permissive attitudes regarding PAS (3.55 vs. 3.93, p < .01).
residents appear to be comfortable with appropriate pain relief even if it
hastens death (indirect euthanasia). here
are, however, clear differences between new interns and more experienced
residents regarding such issues as PAS and futility, suggesting that clinical
experience may change attitudes and behaviors.
Impact: Appropriate end of life care can be a challenge for new physicians and is dependent on attitudes developed during training. Experience alone appears to be a great teacher but may be enhanced by implementation of an end of life care curriculum for residents. It is an important opportunity we should not miss.