with dying patients, particularly for undergraduate medical students, if any, is limited.

Nurses are expected to provide physical, emotional, spiritual, and practical care for patients in every phase of life. They spend more time with patients near the end of life than do any other health professionals. Yet like physicians, most nurses in the United States do not receive the training and practical experience they need to carry out these duties in the best fashion. The nursing curriculum has been less studied than the medical curriculum, but this has been changing, particularly in response to debates about assisted suicide and euthanasia (Ferrell et al., 2000).

Social workers are central to counseling, case management, and advocacy services for the dying and for bereaved families. With their focus on the psychosocial aspects of the dying process, they work not only with patients but with those around them in making decisions about treatment options, marshaling resources, helping families cope with terminal illness and death of a relative, and generally encouraging the best quality of life for all concerned. Just as nursing and medicine have begun to do, the social work profession has been examining its education process for preparing practitioners to care for dying patients and their families. Efforts to improve undergraduate- and master’s-level social work training in this area are just getting under way in the United States, in comparison to the more mature field in Canada and England and in comparison to medical and nursing education (Christ and Sormanti, 1999).

In medicine, nursing, and social work, the following are needed:

  • faculty development,

  • educational materials and curriculum development,

  • coordination among training programs for the variety of professionals involved in the care of dying patients,

  • guidelines for residency programs and increased palliative and end-of-life content in licensing and certifying examinations, and

  • improving the research base for palliative care education.

Inadequate Standards of Care and Lack of Accountability in Caring for Dying Patients
Practice Guidelines

The process of developing standards of care for patients at the end of life is under way, but still at an early stage. Holland and Chertkov (Chapter 7) review the status of practice guidelines for care at the end of life, including both physical and psychosocial components (Table 1-1). The one aspect for which evidence-based guidelines for end-of-life care do exist is pain



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