Factors associated with residents' attitudes toward dying patients.
OBJECTIVE
Management of the dying patient often elicits anxiety in physicians. This study identified the association of physicians' personal fear of death, tolerance of uncertainty, and attachment style with physician attitudes toward dying patients.


METHODS
Four psychological scales were distributed to family practice residents located in Texas, Missouri, and Maine. The scales were "Death Anxiety," "Death Attitudes," "Physicians' Reactions to Uncertainty," and "Experiences in Close Relationships." The scores from the measures and demographic data were used to determine which factors were associated with physician attitudes toward caring for terminally ill patients.


RESULTS
Completed surveys were received from 157 residents. Younger residents (< 30 years) reported more stress from uncertainty and were more uncomfortable with the care of dying patients. Residents who reported higher death anxiety were also more uncomfortable with caring for dying patients. In a multivariate analysis, uncertainty, death anxiety, and age predicted 26% of the total outcome variance of the death attitudes score.


CONCLUSIONS
Physician tolerance of uncertainty plays a significant role in physician attitudes toward the dying patient. Our findings suggest that decreasing physicians' stress from uncertainty by educating them in the management of the dying patient may improve their attitude toward death and may better prepare them to provide end-of-life care.
Kvale
J
J
Department of Family Practice, University of Texas, Houston, USA. jkvale@fpcm.med.uth.tmc.edu
Berg
L
L
Groff
J Y
JY
Lange
G
G
D000223:Adaptation, Psychological; D000328:Adult; D000704:Analysis of Variance; D001007:Anxiety; D001293:Attitude to Death; D005194:Family Practice / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008281:Maine; D008297:Male; D008923:Missouri; D009769:Object Attachment; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D012044:Regression Analysis; D013727:Terminal Care; D013781:Texas