The need for end-of-life care training in nephrology: national survey results of nephrology fellows

doi:10.1016/S0272-6386(03)00868-0

American Journal of Kidney Diseases

Volume 42, Issue 4, October 2003, Pages 813-820

https://doi.org/10.1016/S0272-6386(03)00868-0 Get rights and content

Abstract

Because of the high mortality rate of end-stage renal disease, nephrologists care for many dying patients. However, the education of nephrology fellows in palliative care has not been assessed. We surveyed second-year nephrology fellows to assess the quantity and quality of teaching they received in palliative medicine and also asked about their preparedness to manage patients at the end of life. A 63% survey response rate yielded 173 surveys for evaluation. Nearly all fellows (99%) agreed that physicians have a responsibility to help patients at the end of life; half thought it was very important to learn how to care for dying patients. On a 10-point scale in which 0 is no teaching and 10 is a lot of teaching, fellows reported significantly less teaching in end-of-life care (mean score, 3.8 ± 2.6) than in managing a patient with distal renal tubular acidosis (mean score, 6.3 ± 2.5) or on hemodialysis therapy (mean score, 8.9 ± 1.5; all P < 0.0001). Specific palliative care content areas were taught infrequently; only 22% of fellows were taught how to tell a patient he or she is dying. Fellows who had contact with a palliative care specialist reported more education on end-of-life issues and believed they were better prepared to provide such care. Fellows’ palliative care experiences during fellowship frequently occurred without attending nephrologist supervision; 32% of fellows had conducted 2 or fewer family meetings, and 26% of all family meetings occurred without an attending nephrologist. Fellows believed they were best prepared to manage a patient on hemodialysis therapy (mean score, 8.9 ± 1) and least prepared to manage a patient at the end of life (mean score, 6.1 ± 2; P < 0.0001). Our results show that most nephrology fellows believe they should learn how to care for dying patients, but most fellowship programs do not offer this training. Our study therefore suggests that training in palliative care be incorporated into fellowship program curricula.

Section snippets

Methods

In April 2002, a survey addressing training in end-of-life care was sent to all second-year nephrology fellows in the United States (n = 274). The list of fellows was obtained from the American Medical Association trainee database. Information provided by the American Medical Association was verified and updated based on information provided by directors of individual nephrology training programs. A letter signed by the Chairman of the Training Program Directors Committee of the American

Results

Table 1 lists characteristics of the study group. Eighty-one percent were in the second year of a 2-year fellowship, 16% were in the second year of a 3-year fellowship, and 3% were in their second year of a multiyear (>3 years) fellowship. All respondents were board eligible in internal medicine.

Most respondents (125 of 171 respondents; 73%) characterized themselves as more inclined toward technological and scientific, rather than social and emotional, aspects (27%) of medical care; 66% of

Discussion

This is the first nationally representative study to document the status of education about end-of-life issues among nephrologists in training. Fellows surveyed were in their second year of training, and most were near the completion of training and anticipating a career in clinical nephrology (Table 1). Our results show that nephrology fellows believe they receive good training during fellowship generally, but not in end-of-life care Fig 1, Fig 2. Specifically, they receive little training in

Acknowledgements

The authors thank Stu Linas, MD, for his support of this project and Matthew Pesacreta, MD, for assistance in data collection.

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: Supported in part by a grant from the Robert Wood Johnson's Last Acts Professional Education Subcommittee; an American Society of Nephrology Student Scholar Award (S.S.C.); Project on Death in America Faculty Scholars Program (R.M.A.); Greenwall Foundation (R.M.A.); Ladies Hospital Aid Society of Western Pennsylvania (R.M.A.); International Union Against Cancer Yamagiwa-Yoshida Memorial International Cancer Study Grant Fellowship (R.M.A.); and the LAS Trust Foundation (R.M.A.).

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Special articleThe need for end-of-life care training in nephrology: national survey results of nephrology fellows

Abstract

Section snippets

Methods

Results

Discussion

Acknowledgements

Am J Kidney Dis

Final Report Summary and Recommendations to the Field. Promoting Excellence in End-of-Life Care, Robert Wood Johnson Foundation

Shared Decision-Making in the Appropriate Initiation of and Withdrawal From Dialysis. Clinical Practice Guideline 2

Decisions near the end of lifeProfessional views on life-sustaining treatments

Am J Public Health

Education about death and dying during the clinical years of medical school

Surgery

Academia's chilly climate for primary care

JAMA

Physicians’ ratings of their knowledge, attitudes, and end-of-life care practices

Acad Med

Dialysis patients’ preferences for family-based advance care planning

Ann Intern Med

Special article
The need for end-of-life care training in nephrology: national survey results of nephrology fellows