Both undergraduate licensing and graduate certification examinations have begun to include more questions on end-of-life care, but the content is still minimal. More questions on these exams will likely promote appropriate additions to the curriculum.
In addition to the many unanswered clinical questions surrounding end-of-life care, there is research to be done that could directly benefit the education process. The “epidemiology of dying” would describe where, how, and under whose care patients die in different settings, including the interactions of physicians, nurses, social workers, clergy, family, and other caregivers. Information about the effect on physicians (and others) of caring for dying patients could also help guide medical education.
The transition period of “prognostic uncertainty,” when choices must be made in the face of an uncertain outcome, is relatively unstudied in terms of the choices for patients and physicians.
Medical societies of various kinds, as well as societies of medical educators, can take a leadership role in placing end-of-life care prominently on the educational agenda. They can assess the educational needs of their members, develop clinical practice guidelines, encourage research, highlight end-of-life care at annual and other meetings, and undertake other activities (Weissman et al., 1999).
Standard-setting organizations, such as the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) can promote more comprehensive end-of-life care requirements for hospitals, nursing homes, and other institutions. They also can help to educate medical administrators about quality end-of-life care (Weissman et al., 1999).
Work on many of the identified needs has been started, mainly through foundation grants. These projects have succeeded in raising awareness of the need for improvement and stimulating innovative ideas. The major projects and funding sources are characterized in Table 9-6. The National Cancer Institute also funded a group of grants through a one-time initiative but has no ongoing program for soliciting proposals in this area.