Abstract
BackgroundDespite the benefits to early palliative care in the treatment of terminal illness, barriers to timely hospice referrals exist. Physicians who are more comfortable having end-of-life (EOL) conversations are more likely to refer to hospice. However, very little is known about what factors influence comfort with EOL care.MethodsAn anonymous survey was sent to all the residents and fellows at a single institution. Self-reported education, experience and comfort with EOL care was assessed. Using multivariate logistic regression analysis, variables that influenced comfort with EOL conversations were analyzed.ResultsMost residents (88.1%) reported little to no classroom training on EOL care during residency. EOL conversations during residency were frequent (50.6% reported > 10) and mostly unsupervised (61.9%). In contrast, EOL conversations during medical school were infrequent (3.7% reported >10) and mostly supervised (78.6%). Most (54.3%) reported little to no classroom training on EOL care during medical school. Physicians that reported receiving education on EOL conversations during residency and those who had frequent EOL conversations during residency had significantly higher comfort levels having EOL conversations (p = 0.017 and p = 0.003, respectively). Likewise, residents that felt adequately prepared to have EOL conversations when graduating from medical school were more likely to feel comfortable (p = 0.030).ConclusionsMost residents had inadequate education in EOL conversation skills during medical school and residency. Despite the lack of training, EOL conversations during residency are common and often unsupervised. Those who reported more classroom training during residency on EOL skills had greater comfort with EOL conversations. Training programs should provide palliative care education to all physicians during residency and fellowship, especially for those specialties that are most likely to encounter patients with advanced terminal disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0819-6) contains supplementary material, which is available to authorized users.
Highlights
Despite the benefits to early palliative care in the treatment of terminal illness, barriers to timely hospice referrals exist
Studies have shown the benefits of involving palliative care early in the care of patients with terminal disease
When testing for non-responder bias, no bias was identified for gender (p = 0.608), bias was found when looking at department (p = 0.003), suggesting some participants were more or less likely to respond to our survey based on their department of training
Summary
Despite the benefits to early palliative care in the treatment of terminal illness, barriers to timely hospice referrals exist. Hospice and palliative care services are underutilized, [11] with studies demonstrating that up to 50–55% of terminally ill, hospice eligible patients are never referred by their treating physician [12, 13]. There are many barriers to appropriate and timely hospice referrals, arising from the patient, health care system or physicians [14] Patients and their caregivers may have difficulty accepting the illness as terminal. Physicians often delay discussing hospice and palliative care until late in the disease course [22, 23] They may assume that patients or their families do not wish to know about hospice or Schmit et al BMC Medical Education (2016) 16:297 are unwilling to accept it [12, 24,25,26]. Physicians may delay discussing hospice and palliative care as to avoid uncomfortable conversations and emotions [26, 27]
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