WSU study reveals gaps in end-of-life care education for doctors

Doctors encounter death and dying significantly more than most people. It's the price of saving lives and helping people. 

Medical students in the U.S., however, receive little or no formal training in how to guide patients and their families through end-of-life issues, according to a new review conducted by Washington State University scientists.

Researchers analyzed published papers on medical school death and dying education dating back to 2013. They found43 articles, with variation in how death and dying was taught, including minimal evidence-based education on how to work with patients and their families on end-of-life care. The new paper was published in Academic Medicine. 

Training can help a doctor decrease the fear of death for patients and their families, but it also reduces that fear for the medical professional. Medical students often don't get enough experience with this until they're practicing in the field. Classroom training could get them thinking about the issue before they face it directly with patients."

Raven Weaver, corresponding author on the paper and associate professor in WSU's Department of Human Development

Logan Patterson, who graduated from WSU's Elson S. Floyd College of Medicine with an MD in May, is the paper's lead author. He plans to specialize in radiation oncology.

"Doctors need to be comfortable with the topic of death and talking to patients about it, especially those with cancer," said Patterson, who grew up in Yakima, Washington, and is currently completing a residency in Spokane. "Training for those conversations isn't really taught in medical institutions. A lot of that has to do with required medical testing; multiple choice questions about care planning are hard to write because of the detail required."

The existing research evaluated in the new study mostly employed low-rigor designs, with interventions that emphasized new information, integrating new skills, and assessing patient abilities, but were short in duration. As a result, the researchers advocate for evidence-based educational interventions integrated across medical school curriculum, regardless of anticipated specialty area.

Medical schools are aware of the missing skills, Patterson said, but finding a place to add them is a challenge. He hopes the paper encourages schools to start prioritizing this type of training.

"The first step in figuring out how to teach it is to see how it's currently being taught," said Patterson, who will start radiation oncology training in San Francisco later this year. "We found that it really isn't being taught at all."

He saw firsthand the limited training while in medical school.

"If you do one shift in an emergency room, you'll likely see a patient who hasn't grappled with end-of-life questions," Patterson said. "Several times I saw families bring a patient with a chronic condition to the hospital because they thought that's what the person wanted, only to learn they didn't want to be there. Better training for doctors could head off the confusion before it becomes a time-sensitive condition in the hospital."

Weaver, who specializes in gerontological issues including death and dying, said additional training for doctors could reduce unnecessary medical bills and unwanted treatment.

"Research shows that health care is most expensive in the last year of life, and a lot of that is unwanted treatment," she said. "Physicians, understandably, want to save lives. But they often don't consider quality of life."

Patterson's ultimate goal is to help patients. Having better-educated physicians would be a big step toward making sure others can do the same.

"I think almost any doctor will tell you there's a lack of death and dying training," Patterson said. "It's inevitable that doctors will talk about this with patients. Any boost of knowledge early in their careers will only help them and those they care for."