Few Doctors Receive Adequate Training In End-of-life Care
A Michigan State University study finds that not enough doctors are receiving formal training in end-of-life care, something that could result in more patients receiving treatments that are not only painful or uncomfortable but also ineffective at prolonging life.
The study - published in the most recent issue of the Journal of Palliative Medicine - surveyed 275 residency programs in Michigan and found that fewer than half - 46 percent - provided formal training in end-of-life care, some not offering even a single optional lecture. In addition, fewer than one-fifth - 19 percent - mandatory education that involved patient care.
The study also found that less than a third - 31 percent - offered formal training in hospice care, with only around 15 percent offering mandatory education that involved patient care.
What this all means, said Karen Ogle, a professor of family practice and study director, is that it could be quite some time before patients who are nearing the end of their lives get the care and treatment they need and deserve.
"There have been slight improvements. But the bad news is we are not making huge strides in how we're training these new doctors," she said. "It's grossly inadequate.".
It's extremely important that this type of training be provided at this point in the medical resident's career, said Clayton Thomason, MSU assistant professor in the Department of Family Practice and Center for Ethics and Humanities in the Life Sciences and paper co-author.
"This is when they are really creating their identify as a clinician," he said. "This is when they develop their philosophy of care. If doctors go through this type of training, they'll practice differently.".
Ogle said there remains a reluctance on the part of a number of residency directors to teach new doctors how to bring about a "good death" in their patients.
"There is a common theme that medicine has become too cure-focused or over-technologically focused," she said. "Death is still viewed as a medical failure.
"We remain a death-denying culture. We don't like to talk about it and we don't recognize grief very well.".
There are many solutions to this issue, Ogle and Thomason said, starting with the clinicians and other health-care providers themselves.
"You have to motivate change within the profession," Thomason said. "This can be done through accreditation and examination.".
"We like to say 'if you test it, they will come,'" Ogle said. "If questions about palliative care and hospice are on a licensure exam, people will take notice.".
Michigan tends to have a higher awareness of this issue than most other states, Ogle said. This is due, in part, to the influence of Jack Kevorkian.
"I think we have more key leaders in nursing and medicine in the field of end-of-life care than any other place," said Ogle, who served as co-chairperson, along with Thomason, of the Michigan Governor's Commission on End-of-Life Care.
Ogle also was co-director of the Michigan Partnership for the Advancement of End-of-Life Care, a consortium of nearly 30 state organizations, including MSU and its colleges of Human Medicine, Nursing and Osteopathic Medicine.
The third co-author of the paper was Brian Mavis, director of MSU's Office of Medical Education Research and Development.