they managed patients at the end of life, and were ASCO members, were eligible for the survey, a total of 6,645 (the small number of ASCO members from England and Canada was also included). About 40 percent (2,645) responded (see table below) (Emanuel, 2000). No information is available to compare the characteristics of those who responded with those who did not.

This survey documented serious shortcomings in the training and current practices of a large proportion of oncologists who responded. Among the key findings are the following:

  • Most oncologists have not had adequate formal training in the key skills needed for them to provide excellent palliative and end-of-life care. Less than one-third reported their formal training “very helpful” in communicating with dying patients, coordinating their care, shifting to palliative care, or beginning hospice care. About 40 percent found their training very helpful in managing dying patients’ symptoms.

  • Slightly more than half (56 percent) reported “trial and error in clinical practice” as one important source of learning about end-of-life care. About 45 percent also ranked role models during fellowships and in practice as important. Traumatic patient experiences ranked higher as a source of learning than did lectures during fellowship, medical school role models, and clinical clerkships.

Recommendations to Improve End-of-Life Medical Education

In 1997, the Robert Wood Johnson Foundation and the Project on Death in America brought together 94 academic leaders (selected through a structured nomination process) in a national consensus conference on medical education for end-of-life care (Barnard et al., 1999). Their task was to develop recommendations to guide teaching in end-of-life care, based on evidence from the literature and expert opinion. The work was carried out by eight working groups in the following areas:

  1. Preclinical years

  2. Primary care and ambulatory care

  3. Acute care hospitals

  4. Pediatrics

  5. Emergency medicine

  6. Intensive care

  7. Long-term institutional care

  8. Home care and hospice care



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