Educators and other health professionals should initiate changes in undergraduate, graduate, and continuing education to ensure that practitioners have relevant attitudes, knowledge, and skills to care well for dying patients.

Within medicine, nursing, and social work, the recognition of deficiencies in education are well known, and each profession has at least initiated efforts to improve the status quo. However, the recognition that improvements are needed does not bring the knowledge and tools necessary to accomplish those ends. This is the task that lies ahead and that will require persistent effort and increased and sustained funding for a wide range of activities. Thus far, funding for the major initiatives have been led by private foundations. With successful programs started and ideas for new approaches proliferating however, the amount of funding that can be put to productive use is much greater. Sustained progress at this juncture requires a substantial commitment of support from the public sector as well as continued support for innovation from the private sector.

PHYSICIAN EDUCATION IN END-OF-LIFE CARE

Most U.S. physicians—oncologists, other specialists, and generalists alike—are not prepared by education or experience to satisfy the palliative care needs of dying cancer patients or even to help them get needed services from other providers. With half a million people dying from cancer each year in this country, this is a stark, but robust finding. The strongest sources of supporting evidence are

  • studies during the late 1990s documenting end-of-life and palliative care content in undergraduate and residency coursework, and

  • studies during the late 1990s of medical textbook content on end-of-life and palliative care.

Consistent with these sources are responses given by oncologists to American Society of Clinical Oncology (ASCO) 1998 survey questions about their training in end-of-life and palliative care and their abilities to provide appropriate care of this type (Emanuel, 2000). The evidence is consistent with a lack of funding for end-of-life and palliative care educational initiatives, which has begun to change only recently. Even in 2001, however, the programs are small and funded largely by private grant-making organizations, with little contribution by the federal government. Perhaps even more persuasive is the complete lack of documented disagreement about the poor state of end-of-life medical education.



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