Deficiencies in End‐of‐Life Care Content in Medical Textbooks

Abstract

To the Editor: The care that physicians provide to patients who are at the end of life has recently received much attention. Numerous specialty boards and organizations, including the American Geriatrics Society, have developed professional standards on end-of-life care for their members.1–3 Although deficiencies in care at the end of life have many causes, insufficient training of clinicians in this area is a major reason.4 The textbooks used to train clinicians are partly to blame. Our research has identified major deficiencies in the end-of-life content of more than 50 best-selling medical textbooks, including five top geriatric medicine textbooks.5 Similar findings hold for best-selling nursing and pharmacy books.6,7 In the face of documented textbook deficiencies, we have undertaken an effort to encourage publishers, editors, and authors to improve their textbook's end-of-life content, including book chapters, cross-referencing, and indexing.8 In follow-up to this effort, we recently surveyed textbook publishers and editors to assess their progress in revising their texts. We are pleased to report a positive response. To date, 23 editors and 19 publishers of 50 top-selling medical textbooks have responded to our follow-up survey. They report planned or completed expansion of end-of-life content in the next editions of 22 textbooks, including 17 textbooks with new end-of-life care chapters, 17 with revised indexes, and 11 with expanded cross-referencing. Thus, of the 50 textbooks, more than one-third are planning to expand or have already expanded end-of-life care content in their next editions. Finally, we have received six personal letters from editors and publishers who have been supportive of this project, including a poignant one from a textbook editor who was himself dying of metastatic melanoma at the time he wrote. Recently, the Robert Wood Johnson Foundation honored the medical, nursing, and pharmacy textbook publishers, editors, and authors who have been working to make these important changes. On February 21, 2001, at an awards ceremony at the Last Acts Project National Meeting, the authors presented awards to one medical textbook publisher (Lippincott, Williams, and Wilkins) and to the editors of three medical textbooks (Emergency Medicine, 5th Edition, editor-in-chief: Judith Tintinalli; Nelson Textbook of Pediatrics, 16th Edition, editors: Richard Behrman, Robert Kliegman, and Hal Jensen; and Textbook of Primary Care Medicine, 3rd Edition, senior editor: John Noble). Unfortunately, there is still much work to be done. Many best-selling textbooks have not yet responded to the suggestions of their specialty boards, the needs of their readers, or the demands of patients and families to improve clinician education in care of patients at the end of life. We will continue monitoring textbooks over the next several years, and the Robert Wood Johnson Foundation will continue to offer awards to those publishers, editors, and authors who improve the end-of-life content in their books. It is essential that the current knowledge base for providing excellent palliative care and the ongoing research published in this journal quickly diffuse into the best-selling geriatric medicine textbooks.