Difficulties Facing Junior Physicians and Solutions Toward Delivering End-of-Life Care for Patients with Cancer: A Nationwide Survey in Japan

Abstract

Background: Junior physicians' perceived difficulty in end-of-life care of patients with cancer has not been structurally investigated; therefore, current challenges and solutions in this area remain unknown. Objectives: To identify some difficulties junior physicians face in delivering end-of-life care for patients with cancer and to clarify the support required to reduce these difficulties. Design: A nationwide survey was conducted in over 300 institutions selected randomly from 1037 clinical training hospitals in Japan. Participants: From each of these institutions, two resident physicians of postgraduate year (PGY) 1 or 2, two clinical fellows of PGY 3–5, and an attending physician were requested to respond to the survey. Measurements: The survey investigated issues regarding end-of-life care using the palliative care difficulties scale with two additional domains (“discussion about end-of-life care” and “death pronouncement”). Items related to potential solutions for alleviating the difficulties as well were investigated. Results: A total of 198 resident physicians, 134 clinical fellows, and 96 attending physicians responded to the survey (response rate: 33.0%, 22.3%, and 32.0%). The results revealed that junior physicians face difficulties within specific domains of end-of-life care. The most challenging domain comprised communication and end-of-life discussion with patients and family members, symptom alleviation, and death pronouncement. The most favored supportive measure for alleviating these difficulties was mentorship, rather than educational opportunities or resources regarding end-of-life care. Conclusion: The findings of this study reveal the need for further effort to enrich the mentorship and support systems for junior physicians delivering end-of-life care.

Determinants of Attitude Toward End-of-Life Care Among Junior Physicians: Findings from a Nationwide Survey in Japan

“… 33 Moreover, this is consistent with a previous report that the availability of attending physicians with whom junior physicians can easily consult was selected as the most favorable support measure to promote confidence about end-of-life care among junior physicians. 12 This confirms the importance of having a close mentor–mentee relationship in an end-of-life care clinical setting for junior physicians. In the same study, the second most helpful support measure was the availability of staff and departments where junior physicians can discuss their mental burden and stress.…”

“…This secondary analysis of a nationwide survey was administered to junior physicians in the departments of internal medicine and surgery at government-designated clinical training hospitals in Japan. 12 The government-designated clinical training hospitals are required to satisfy the comprehensive criteria on size (300+beds, with 3000+ inpatient admissions per year), assignment of independent multiple clinical departments including emergency medicine and full-time employed mentor physicians, number of full-time employed physicians, and number of autopsies per year, among other conditions. 27 Junior physician is defined as residents of postgraduate year (PGY) 1 or 2, and clinical fellows of PGY 3–5.…”

“…The survey process is described elsewhere. 12 The participants were from 300 institutions selected randomly from 1037 government-designated clinical training hospitals in Japan. Two resident physicians and two clinical fellows at each institution were requested to respond to the survey (each include one internal and surgical junior physician, respectively).…”

“… 8–11 However, communication, end-of-life discussion with patients and family members, symptom alleviation, and death pronouncement are the most challenging components of end-of-life care among junior physicians. 12–15 Moreover, a nationwide survey of bereaved families in Japan revealed that only 38% answered that the patient was experiencing little suffering and physical pain, and only 44% thought that the patient was able to receive satisfactory treatment. 16 Regarding communication, only 30% indicated that there was sufficient communication between the patient and the physician on topics such as preferred place of death and life-prolonging treatments.…”

“…16 Despite these difficulties and clinical challenges, physicians often do not receive sufficient education or training in providing end-of-life care and feel unprepared to care for terminally ill patients (e.g., only 20% of physicians responded that they “received sufficient education regarding palliative and end-of-life care,” and only 30% responded that they had “sufficient knowledge and skills regarding alleviation of symptoms of end-of-life patients” in Japan). 12–15 , 17 , 18 …”