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Improving Palliative Care for Cancer
TABLE 9-3 AAMC Medical School Graduation Questionnaire: Level of Coverage of Death and Dying and Pain Management 1998 Survey (N= 13,861 responses out of 14,040 eligible)
Excessive No. (%)
Appropriate No. (%)
Inadequate No. (%)
Death and dying
SOURCE: Barzansky et al., 1999.
plored in the recent literature in different ways. A wide-ranging review of published literature and grant proposals for end-of-life care by Billings and Block (1997) has brought together the relevant material.
Billings and Block (1997) searched the published literature for articles on palliative care and related topics for the years 1980 through 1995 and reviewed palliative care education grants funded by the National Cancer Institute or submitted for funding to the Project on Death in America. One hundred eighty articles—culled from more than 9,000 potentially relevant citations—form the basis of their analysis. Their findings, which complement and support the findings of the recent surveys discussed earlier, are summarized here.
CURRICULUM IN END-OF-LIFE CARE Some of the literature reviewed by Billings and Block (1997) represented reports of the surveys of medical school deans in years earlier than those characterized by Barzansky and colleagues (1999). The following findings were reported from the 1989 survey of medical school deans, which at the time numbered 124, of whom 111 responded (Mermann et al., 1991).
Twelve of the schools had no curriculum at all in death and dying. In 30 schools, one or two lectures on death and dying were included in other courses. In 51 schools, it was taught as a distinct module in a required course, consisting of four to six lectures or a combined lecture and seminar series with small-group discussion. Eighteen schools offered a separate course on death and dying, which was required in the first two years by nearly half of the schools. The format varied from a one-weekend workshop to semester-long lecture and seminar classes, with the lecture format predominating (15 schools). There was very little contact with dying patients in any program.
The class presidents of all U.S. medical schools were polled in 1991 about terminal care education (Holleman et al., 1994). Among the findings highlighted by Billings and Block are