TABLE 9-5 End-of-Life Care Content of 50 Textbooks: Specialties, Content Domains, Scoring

Specialties Included (No. of books)

Content Domains

Scoring

Cardiology (4)

Emergency medicine (4)

Family and primary care medicine (5)

Geriatric medicine (5)

Infectious disease and AIDS (3)

Internal medicine (6)

Neurology (3)

Oncology and hematology (6)

Pediatrics (4)

Psychiatric medicine (3)

Pulmonary medicine (4)

Surgery (3)

Epidemiology (vital statistics)

Natural history (prognosis, time course, mode of death, symptoms)

Pain management

Nonpain symptom management (dyspnea, nausea and vomiting, delirium, fatigue, etc.)

Psychological issues (depression, anxiety, fear, loneliness, grief)

Social and demographic issues (interpersonal relationships with spouses or partners, family, and friends; race; cultural and economic issues)

Spiritual issues (abandonment, completion of tasks, acceptance, religious tasks, choices)

Family issues (communication of patient and family member wishes, grief and bereavement, informal caregiver role and support, education, economic issues) Definition of end-of-life care (definition of death and goals of care)

Ethics Law Policies (individual vs. organization ethics, patients’ self-determination, double effect, withdrawal and withholding of life support)

Physician after-death responsibilities (pronouncement, autopsy, organ donation)

Physician roles (communication with patient and family, personal grief and bereavement)

Context of care (advance directives, options for end-of-life care, referral to hospice, funeral arrangements)

0: Absent

1: Minimal

2: Helpful

 

SOURCE: Rabow et al., 2000

worst were social, spiritual, and family issues; ethics, and physician responsibilities. In the remaining domains, minimal information (a rating of 1) was most common.

Ten conditions were appropriate to more than one specialty, and these included two cancers: lung cancer and leukemia. Lung cancer was covered in family and primary care medicine, internal medicine, and oncology-hematology; leukemia in family and primary care medicine and pediatrics, in addition to oncology-hematology. For lung cancer, oncology-hematology had the lowest helpful score (11.6 percent), followed by internal medicine (20.5 percent), and family and primary care had the best helpful score



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