Perceived competency and knowledge in palliative and end-of-life care among physicians at an academic institution.

Abstract

59 Background: Given the importance of palliative and end-of-life (EOL) care in terminally ill patients (pts), it is crucial that physicians feel comfortable in leading EOL discussions and possess adequate knowledge in palliative care skills. Methods: We conducted an online survey of physicians at our institution to evaluate competency and knowledge in palliative and EOL care. The survey consisted of 39 questions in self-assessed skills and a 26-question validated knowledge test. Results: There were a total of 70 respondents across specialties: 30% internal or family medicine, 24.3% surgery, 14.3% pediatrics, 31.4% other, 5.7% medical/surgical oncology. The median (M) age was 52.5 (33-99), 64% were male. 18.6% reported caring for 1 to 2 dying pts and 35.7% for 3 to 10 or more dying pts in the previous 3 months (mos). 45.7% had 1 or more EOL discussions in the previous 3 mos. There was no association between (btw) the number of dying pts cared for and the number of EOL discussions, p < 0.89. 31.4% felt comfortable and 15.7% felt very comfortable providing palliative/EOL care, while 18.6% felt very uncomfortable or uncomfortable and the plurality, 34.3%, felt neither comfortable nor uncomfortable. Physicians who were comfortable or very comfortable were 1.63 times more likely to have 2 or more EOL discussions in the previous 3 mos, p < 0.0001. When rating competency level in various skills, 80% reported average (avg) to above avg skill in pain assessment, 58.6% below avg to avg in opioid dosing, 64.3% below avg to avg in managing opioid side effects, 65.7% avg to above avg in assessing non-pain symptoms. The M score on the knowledge test was 69.2 (46.1-88.4) % correct, with most incorrect answers in managing cancer pain. There was no correlation btw test score and overall comfort level, p < 1.567. Conclusions: In our cohort, the plurality of respondents felt neither comfortable nor uncomfortable in providing palliative and EOL care, self-assessed competency was often rated as below avg or avg, and overall comfort level did not correlate with knowledge test scores. This study highlights the need to improve continuing medical education in palliative and EOL care in order to enhance the quality of care physicians provide to pts.