North Shore-LIJ Health System,Great Neck, New York.
Palliat Support Care. 2014 Jun;12(3):195-201. doi: 10.1017/S1478951512001101. Epub 2013 May 14.
As medical education evolves, emphasis on chronic care management within the medical curriculum becomes essential. Because of the consistent lack of appropriate end-of-life care training, far too many patients die without the benefits of hospice care. This study explores the association between physician knowledge, training status, and level of comfort with hospice care referral of terminally ill patients.
In 2011, anonymous surveys were distributed to physicians in postgraduate years 1, 2, and 3; fellows; hospital attending physicians; specialists; and other healthcare professionals in five hospitals of a large health system in New York. Demographic comparisons were performed using χ2 and Fisher's exact tests. Spearman correlations were calculated to determine if professional status and experience were associated with comfort and knowledge discussing end-of-life topics with terminal patients.
The sample consisted of 280 participants (46.7% response rate). Almost a quarter (22%) did not know key hospice referral criteria. Although 88% of respondents felt that knowledge of hospice care is an important competence, 53.2% still relinquished advance directives discussion to emergency room (ER) physicians. Fear of patient/family anger was the most frequently reported hospice referral barrier, although 96% of physicians rarely experienced reprisals. Physician comfort level discussing end-of-life issues and hospice referral was significantly associated with the number of years practicing medicine and professional status.
Physicians continue to relinquish end-of-life care to ER staff and palliative care consultants. Exploring unfounded and preconceived fears associated with hospice referral needs to be integrated into the curriculum, to prepare future generations of physicians. Medical education should focus on delivering the right amount of end-of-life care training, at the right time, within the medical school and residency curriculum.
随着医学教育的发展，在医学课程中强调慢性病管理变得至关重要。由于临终关怀培训的持续不足，太多患者在没有临终关怀的情况下死亡。本研究探讨了医生的知识、培训状况和对终末期患者临终关怀转诊的舒适度之间的关联。
2011 年，在纽约一家大型医疗系统的五家医院，向住院医师 1、2、3 年级、研究员、住院医师、专科医生和其他医疗保健专业人员分发了匿名调查。使用 χ2 和 Fisher 精确检验进行人口统计学比较。计算 Spearman 相关系数，以确定专业地位和经验是否与与终末期患者讨论临终话题的舒适度和知识相关。
样本包括 280 名参与者（46.7%的回复率）。近四分之一（22%）的人不知道关键的临终转诊标准。尽管 88%的受访者认为了解临终关怀是一项重要的能力，但仍有 53.2%的人将预先指示讨论交给急诊室（ER）医生。对患者/家属愤怒的恐惧是最常报告的临终转诊障碍，尽管 96%的医生很少经历报复。医生讨论临终问题和临终关怀转诊的舒适度与行医年限和专业地位显著相关。
医生继续将临终关怀交给急诊室工作人员和姑息治疗顾问。需要将与临终转诊相关的无根据和先入为主的恐惧纳入课程，为未来几代医生做好准备。医学教育应侧重于在医学院和住院医师课程中适时提供适量的临终关怀培训。
