Experiences in end-of-life care in the Intensive Care Unit: A survey of resident physicians

Abstract

Background and Aims:The practice of intensive care includes withholding and withdrawal of care, when appropriate, and the goals of care change around this time to comfort and palliation. We decided to survey the attitudes, training, and skills of intensive care residents in relation to end-of-life (EoL) care. All residents at our institute who has worked for at least a month in an adult Intensive Care Unit were invited to participate.Materials and Methods:After Institutional Ethics Committee approval, a Likert-scale questionnaire, divided into five composite measures of EoL skills including training and attitude, was handed over to individual residents and completed data were anonymized. Frequency and descriptive analysis was performed for the demographic variables. Central tendency, variability, and reliability were examined for the five composite measures. Scale internal consistency was checked by Cronbach's coefficient alpha. Multivariate forward conditional regression analysis was conducted to examine the association of demographic data or EoL experience to composite measures.Results:Of the 170 eligible residents, we received 120 (70.5%) responses.Conclusions:Internal medicine residents have more experience in caring for dying patients and conducting EoL discussions. Even though majority of participants reported that they are comfortable with the concept of EoL care, this does not always reflect the actual practice in the hospital. There is a need for further training in skills around EoL care. As this is a self-assessment survey, the specific measures of attitudes and skills in EoL are poorly reflected, indicating a need for further research.

Self-Assessment of Knowledge in Paliative Care by Physicians Resident of a University Hospital

“…In our study, 67.7% reported having received information on how to "give bad news" to patients and family members, a result that is similar to those observed in another study conducted in India 23 , where the majority of a sample of 120 resident physicians responded that they felt prepared to discuss prognosis and treatment goals with patients and family members. The communication of bad news is one of the most difficult and most frequent tasks in the practice of health professionals.…”

Knowledge and Awareness of End-of-life Care among Doctors Working in Intensive Care Units at a Tertiary Care Center: A Questionnaire-based Study

“…Our results are comparable to those of Chen et al 12 and Mohamed et al 13 in that the respondents expressed a moderate level of comfort in discussing EOLC issues with the families of critically ill patients. In contrast to the findings of Chen et al 12 and Mohamed et al, 13 we found that anesthesia residents expressed more competency and comfort in dealing with EOLC.…”

Conhecimento sobre cuidados paliativos entre médicos residentes de hospital universitário

“…This proportion was similar to that of Lech, Destefani and Bonamigo 14 , in which 77.5% of the clinical staff of a university hospital considered their ability to transmit bad news to the patient as good/very good. Another study, conducted in India by Mohamed et al 15 , showed that the majority of a sample of 120 resident physicians feel comfortable discussing prognosis and treatment goals with patients and family members. However, the same research 15 showed that when the communication involved more delicate issues, more than half (75%) of the physicians never participated in meetings with family members.…”

“…Another study, conducted in India by Mohamed et al 15 , showed that the majority of a sample of 120 resident physicians feel comfortable discussing prognosis and treatment goals with patients and family members. However, the same research 15 showed that when the communication involved more delicate issues, more than half (75%) of the physicians never participated in meetings with family members. This contradiction was explained by the fact that the research was self-assessing, that is, the doctors could even say that they felt safe to give bad news, but in reality, when the information to be given was more delicate, many of them did not deliver it.…”