Advocating for Training in End-Of-Life Conversations With Seriously Ill Patients During Residency

Abstract

According to section IV.B.1.e of common residency program requirements from the Accreditation Council for Graduate Medical Education (ACGME), “[r]esidents must learn to communicate with patients and families to partner with them to assess their care goals, including, when appropriate, end-of-care [EOL] goals”. EOL conversations are frequently appropriate for patients suffering from serious, life-threatening diseases (ie, terminal illness) or otherwise chronic health conditions with poor disease trajectories. These conversations are often followed with services and care from palliative medicine or hospice specialists depending on patients' projected prognoses (ie, 6 months or less). The focus of this patient-centered care, then, is on relieving patient and caregiver suffering, establishing clear treatment goals, and managing the physical, psychosocial, and spiritual burdens of disease. Although palliative medicine and hospice care have been shown to reduce health care costs and improve the overall care of patients who require these services, recent literature still suggests a gap in training programs being able to provide effective, educational strategies to their trainees regarding the appropriate and competent delivery of EOL conversations. Herein, this commentary will provide a discussion on what EOL is, palliative vs hospice care indications, and address current literature regarding EOL exposure within training programs while offering our personal insight and advocacy on the manner.