End-of-Life Care Influenced by Physicians' Knowledge and Attitudes

Less than half of physicians report that they are well-trained to care for patients with terminal illnesses and about three-quarters of physicians feel knowledgeable enough to discuss hospice with patients and families, according to a study published by Yale researchers in the journal Academic Medicine.

The study assessed physician knowledge and attitudes concerning referrals for hospice and whether knowledge and attitude-factors medical school curricula may be able to affect-influence their practices in end-of-life care. Among the many findings, the study revealed that physician attitudes toward hospice differed in systematic and identifiable ways.

“Male physicians had less positive attitudes toward hospice than female physicians,” said the study’s first author Elizabeth H. Bradley, assistant professor in the Department of Epidemiology and Public Health at Yale School of Medicine. “Oncologists had less positive attitudes concerning hospice (despite higher self-rated knowledge) than internists, perhaps because they perceive that they have expertise in terminal care themselves. Physicians without board certification also reported less positive attitudes toward hospice and toward physician-patient communication concerning end-of-life care than board-certified physicians.”

Bradley said there is a link between greater knowledge and more positive attitude toward hospice and a greater tendency to refer to hospice. “This suggests that influencing knowledge and attitudes in this area in medical school curricula and elsewhere may indeed result in changes in physician practices at the end of life,” she said.

Bradley said the study also suggests that educational interventions to enhance knowledge concerning terminal care and hospice may be most needed among certain specialties, including cardiology, pulmonology, and other subspecialties. Yet, as previous research suggests, knowledge alone may be insufficient to change physician practices.

“Our findings indicate that attitudes can be an important determinant of behavior, especially those attitudes most specific to the targeted behavior,” said Bradley. “Attitudinal changes within the medical profession are a substantial undertaking. Yet, particularly among some specialties, interventions that address physician attitudes may be essential to enhancing the use of hospice for appropriate patients and their families.”

The study was supported by the Nathan Cummings Foundation and was conducted in collaboration with the John D. Thompson Hospice Institute for Training, Education, and Research. Co-authors include Laura D. Cramer, Sidney T. Bogardus, Jr., M.D., Stanislav V. Kasl, Rosemary Johnson-Hurzeler and Sarah M. Horwitz.

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Karen N. Peart: karen.peart@yale.edu, 203-432-1326