A Medical Resident Inpatient Hospice Rotation: Experiences with Dying and Subsequent Changes in Attitudes and Knowledge

摘要

Purpose:To evaluate intern experience in end-of-life care and self-assessed changes in attitude and knowledge, following a mandatory rotation on an inpatient hospice and in a nursinghome.Subjects and Methods:Twenty-seven interns enrolled in an internal medicine residencyprogram completed a questionnaire examining experiences with dying patients, priortraining in end-of-life care, and self-ratings of pertinent attitudes and knowledge. The questionnaireused a retrospective before and after design. Comparisons were evaluated using dependenttwo-tailed r-tests.Results:Prior training was largely limited to undergraduate didacticcourses. Few interns had received formal training in symptom management. Most feltpoorly prepared to care for terminally ill patients. Eighty-two percent of interns had previouslycared for a dying patient only in acute care. Fifty-nine percent had never cared for a dyingpatient without intravenous fluids. Prior modeling of end-of-life care communication byattending physicians was uncommon. On a 5-point scale (strongly disagree-strongly agree)mean responses increased from 2.1 before-rotation to 3.0 after-rotation (p<0.001) for the statement,"I feel as comfortable with a dying patient as I do with any other patient." Pain managementknowledge increased from 2.0 before-rotation to 3.8 after-rotation (p<0.001). Seventy-seven percent strongly agreed with the statement, "some training in care of terminallyill patients should be mandatory for all internists."Conclusions:Prior experiences did not adequatelyprepare interns to deliver competent care. Significant improvements in attitude andknowledge were noted following the intervention. More hands-on clinical experiences in end-of-life care for residents are needed. Occasional didactic sessions will be inadequate.